Pediatric Coding Alert

These 4 real-life scenarios test your globalization versus itemization skillsJust because another group beats you to the punch in filing a fracture care claim doesn't mean you have to forfeit pay, provided you're savvy at breaking up the package -- and getting the other entity to do the same.Test your fracture care coding aptitude with these scenarios.Roll Components Into Global Care CodeExample 1: A pediatrician treats a clavicle fracture by putting the child's arm in a sling and sees the child for follow-up (FU). Which CPT code should you use?When a physician treats a fracture and provides the after-care, you should report the global fracture care code (such as 23500, Closed treatment of clavicular fracture; without manipulation), says Charles Scott, MD, FAAP, pediatrician at Medford Pediatric and Adolescent Medicine in southern New Jersey. These pay for the restorative care, first cast/splint and FU care visits for a designated period, such as 90 days.Piecemeal Care When You Do Only FUExample 2: A hospital emergency department's (ED's) manipulative fracture care policy calls for the ED physician to assess/evaluate an injury, have an orthopod treat the fracture and the primary care physician provide all FU care. How should the physicians code their roles?The ED physician, orthopod and pediatrician should divide the care. Piecemeal the aftercare visits with the pediatrician using E/M codes, Scott says.The orthopod would code the manipulative fracture care with modifier 54 (Surgical care only) for the procedure care only, Scott says. Only the physician who provides the restorative treatment and is responsible for the initial cast, follow-up evaluation(s) and the management of the fracture until healed should use the global code. The ED physician should report an ED visit (99281-99285) for the injury assessment/evaluation and any temporary casting for stabilization. "If cast application or strapping is provided as an initial service (e.g., casting of a sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate," states CPT's casts and straps application notes.The pediatrician would then report the individual office visits, as well as any other x-rays, procedures, or casting that he may perform. Or, the pediatrician could bill the fracture care with the postoperative portion by using modifier 55 (Postoperative management only).Work Out Shared KinksExample 3: An ED physician bills the global fracture care code and sends the patient with a report to her pediatrician with a request for follow-up care. Should the pediatrician use a consultation code?Error averted: The pediatric office should not bill [...]