Orthopedic Coding Alert

Reader Questions:

Repair of Hand Fractures

Question: If a patient has two finger fractures, and a wrist fracture of the same hand, how do you modify these procedures for the maximum reimbursement without getting in trouble?

Maureen E. Gaiser, Office Manager
John L. ODonnell, M.D., Orchard Park, NY

Answer: The wrist fracture is the major procedure so it would be coded first (add a HCPCS modifier LT or RT to show whether the wrist fracture is on the left side or right side). The finger fractures can be reported separately (on different lines) and modified using a HCPCS modifier F1-F4 (left hand, _digit) or F5-F9 (right hand, _digit), which shows which side and which finger is fractured. Also, the modifier -51 for multiple procedures should be attached to the finger fractures, since all fractures have global follow-up days. Utilizing modifiers can help deter claims denials and get maximum reimbursement.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Orthopedic Coding Alert

View All