Orthopedic Coding Alert

Did you know traction can accompany closed fracture treatment?

When your orthopedist performs closed fracture treatment, several coding gears need to start grinding in the mind of the coder.

Why? You’ll have a series of questions to answer surrounding the treatment of the fracture before you can close out the claim. These questions have answers, and we’ve got an expert to guide us to that place.

Check out this Q&A on closed fracture treatment with answers provided by Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, CCS, AAPC Approved Instructor during her HEALTHCON 2022 session “Orthopedic Procedure Coding in the Office.”

Report Closed Treatment? Yes

The first step in coding for closed treatment fractures is knowing its definition for coding purposes. “In closed treatment, the fracture site is not surgically opened. It can be performed with manipulation, without manipulation or with or without traction,” explained Clements.

Report Splinting/Casting? Probably not

During closed treatment, you likely won’t be able to report any casting/splinting/strapping, Clements confirms.

“This service is always bundled into restorative treatment reported on the same date of service,” she says; however, “cast, splint and strapping may be reported when the service is performed without restorative treatment or it is a replacement procedure performed during or after the post-op period.”

And when it comes time for the cast/splint/strap to come off, the removal is bundled into the fracture care package when performed by the same group practice.

Code Separate E/M? Maybe

There are instances in which you could report a separate evaluation and management (E/M) service in addition to the closed treatment. These E/Ms would likely fall under the office outpatient E/M code set 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.), but other E/Ms are possible prior to fracture care.

Best bet: Make sure you can identify a separate, significantly identifiable E/M prior to the decision for surgical treatment before considering coding a preoperative E/M. If you’re unsure what might constitute a separate E/M, check with your provider and/ or payer.

Include Modifier? Maybe

When it comes to modifiers, Clements listed several that you might use on your closed fracture treatment claims:

E/M Modifiers

These modifier could be in play when coding E/Ms associated with a closed fracture treatment scenario:

• Modifier 57 (Decision for surgery)
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)
• Modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period)

Surgical Modifiers

• These modifier could be in play when coding separate surgical services associated with a closed fracture treatment scenario:
• Modifier 50 (Bilateral procedure)
• Modifiers RT (Right side) and LT (Left side)
• Modifier 54 (Surgical care only)
• Modifier 55 (Postoperative Management Only)

Include Documentation? Yes

As with all claims, Clements stressed the importance of documentation for closed fracture treatments during her HEALTHCON presentation. “All procedures performed in the office or at the patient’s bedside are required to have a note. The procedure note can be documented within the clinic note. It does not need a separate report,” she said.

The procedure note should consist of:

• Consent
• Location
• Indications
• Preparation of site including local anesthetic
• Instrumentation (when applicable)
• Medication name and dosage (when applicable)
• Size and (when applicable)
• Toleration of procedure.