Orthopedic Coding Alert

Question: How should we bill when the patient presents to us after going to an emergency room in another town, and he is already in a long arm splint? Should we charge for full fracture care with modifier-55 (postoperative management only), or just for office visits, x-rays, casting materials, etc., with modifier -55 at each visit?

Illinois Subscriber

Answer: Figuring out what to do in a case such as this requires careful review of the instructional notes that precede the Application of Casts and Strapping codes (29000-29799). If you do so, you will discover that your physician may report one of the global fracture treatment codes because CPT states restorative treatment or procedure(s) rendered by another physician following the application of the initial cast/splint/strap may be reported with a treatment of fracture and/or dislocation code.

You do not need to report the -55 modifier. The physician who rendered the care in the emergency room should have reported the appropriate-level E/M code along with 29105 (application of long arm splint [shoulder to hand]) and should not report a global fracture care code if he or she was aware that the patient would be returning to his home town and not following up during the 90-day postoperative period.