Revenue Cycle Insider

Make a cheat sheet for patient billing education.

As an orthopedic coder, assigning the correct codes for fracture treatments may seem straightforward, but you need to consider other factors before submitting the claim. “Fracture care coding — this involves a lot more than just knowing the right CPT^® and ICD-10-CM codes,” said Jessyka Burke, BSHA, CPC, COSC, CASCC, regional practice manager at Northwest Foot and Ankle Center, PS, during her HEALTHCON 2025 session, “Break Into Fracture Care Coding.”

Check out the following tips to improve your fracture care coding to ensure accurate reimbursement for your providers and answer billing questions from patients.

Tip 1: Understand What’s Needed for Fracture Care Coding

“Fracture care coding is a detailed process that requires a thorough understanding of the anatomy that’s involved, the different types of fractures, the specific treatments that are provided, and the nuances of billing and coding guidelines of these fractures,” Burke said.

Refresh your knowledge of the factors affecting correct code selection with the following examples:

1. Fracture type: Open, closed, displaced, nondisplaced, comminuted
2. Treatment modalities: Nonoperative (splints/casts), operative (surgery)
3. Anatomy: Specific bones that were broken
4. Healing status: Fracture still healing, follow-up visit after healing
5. Duration of care: Care provided during an initial encounter or follow-up visit

Tip 2: Know When to Bill Global vs. Itemized Care

Determining how to bill for fracture treatments depends on the type of break because a more severe fracture could require multiple encounters for treatment. In patient cases with several visits needed, you may need to itemize the fracture care billing as opposed to reporting the global package.

“Most providers have learned that it’s based upon how many times you’re going to see the patient back. If you’re only going to see them one or two times, it might be better to do global package. If the provider is going to have to see the patient multiple times, it’ll be better to do itemized,” Burke explained.

For example, a patient presents with a closed, nondisplaced radius shaft fracture of the right arm. The physician captures two-view X-rays, performs a closed treatment, and applies a short arm cast. You’ll report the appropriate evaluation and management (E/M) code with modifier 57 (Decision for surgery), 25500 (Closed treatment of radial shaft fracture; without manipulation), 73090 (Radiologic examination; forearm, 2 views), and 29075 (Application, cast; elbow to finger (short arm)). In this example, reporting the global codes puts the patient in a 90-day surgical package that covers this first encounter for diagnosis and treatment as well as a follow-up visit to evaluate the healing.

However, in the event the patient had an open, displaced fracture that required significant attention for treatment, the provider may opt to bill for each encounter separately.

“I give my providers key phrases to alert me when they want to bill global care. They just add a little line that says, ‘billing fracture care for this patient,’ and then we know that we're going to bill a CPT^® code and not the itemized care for that procedure,” Burke added.

In general, you’ll assign a fracture care code designated as a closed treatment without manipulation along with the initial E/M visit appended with modifier 57, as this reporting accurately represents the physician’s services with the documentation supporting the procedures.

Tip 3: Ensure Patient Understands Their Care

Medical billing is complicated, and it can be difficult for patients who don’t deal with it every day to understand the intricacies of the process. “You need to educate your patients on what fracture care is and what treatment comes with it,” Burke said.

She explained that coders and billers know that CPT^® codes for fracture care are listed under the surgical codes, so don’t be surprised if a patient contacts the office wondering why they were billed for a surgical code if they didn’t have surgery. “You can kindly explain that the patient didn’t have surgery, but the physician performed a type of treatment that gives the patient a 90-day global, so they won’t have copays for office visits related to the injury,” Burke added.

Make sure the patient understands the billing process ahead of time with clear communication, simple language, and visual aids.

Cheat sheet: Burke also stated her office created a fracture care fact sheet for their patients, so they understand why their payer is being billed with a global code and why there might be separate charges for additional services (e.g., follow-up X-rays, additional casts).

“We keep these in the waiting room and also in the exam rooms. We’ve noticed a lot of patients will pick them up in the waiting room and read it over,” she said.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC