ED Coding and Reimbursement Alert

You-ll also need to determine open/closed before coding the treatment You could land on the wrong fracture care code or double dip on the follow-up aftercare unless you-ve got a grip on these essential treatment coding conventions. 1. Check if Fracture Is Open or Closed The first thing you-ll need to deduce from fracture care documentation is whether the physician treated an open or closed fracture. Your ED physician will typically treat closed fractures, explains Michael Lemanski, MD, ED billing director at Baystate Medical Center in Springfield, Mass. He may or may not need to perform reduction to treat a closed fracture. "An open fracture occurs when the bone has punctured through the skin, or there is a significant break in the skin directly over the fracture site -- not just an abrasion or superficial laceration," says Sharon Richardson RN, compliance officer with Emergency Groups- Office in Arcadia, Calif. "This makes the fracture more complex, because it is usually angulated, and needs reduction," Lemanski explains of open fractures. Catch this: "Open fracture treatment is rarely done in the ED; these patients are usually taken to the OR, as there is significant risk of infection, and open fracture treatment usually requires some type of fixation device," according to Richardson. ED scenario: A pedestrian is struck by a motor vehicle while crossing the street; an exam reveals her right ankle is broken and the bones are protruding through the skin. The ED physician will stabilize the patient and ultimately the orthopedist will provide the open fracture care. 2. Look for Manipulation Evidence You must next find out if the physician used manipulation to arrive at the proper code choice; CPT's fracture care codes specify whether or not the physician per-formed manipulation Definition: Manipulation of a fracture involves the physician moving or adjusting the injured bone. Physicians perform manipulation "so the fractured bone returns to its natural orientation and configuration," explains Linda Martien CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla. "Most open fractures require manipulation and usually operative internal fixation by the orthopedist," Lemanski says. The physician should manipulate any displaced fracture to improve the bones- alignment. Don't miss: Your ED physician, however, will also typically perform manipulation on a closed fracture. For instance, a cyclist veers from the road and crashes to the ground, causing a fall on an outstretched hand (FOOSH) injury. A level-three exam reveals an angular deformity of the right wrist with swelling and ecchymosis. The ED physician diagnoses a fracture of the distal radius on the right wrist, which he manipulates to properly reduce the fracture. The physician places a fiberglass cast on the injury, helps the patient schedule follow-up visits with an [...]