Primary Care Coding Alert

Ethically add $$ to claim by reporting fracture care codes instead of E/M Wondering when you should report fracture care instead of an E/M service? You are not alone. Coders will not find a clear-cut answer to when they should report fracture care and when they should bill an E/M service and casting instead. Experts say that the proper code selection will likely depend on the individual case. Take the following factors into account when making your decision to find the best fit for your claim. Consider Fracture Care for Global Care When you are wondering whether you should report fracture care, consider whether the scenario meets the following criteria:

--The FP is seeing the patient for her initial visit for the injury (fracture or dislocation).

--The injury is recent enough that it has not already healed on its own.

--The patient has not had surgery for this injury by another physician in a different practice. (For example, if the patient was injured while on vacation, had surgery and now is home and seeking follow-up, you cannot bill fracture care.)

--The FP provides a restorative treatment or procedure and plans to care for this injury for the next 90 days. Example: A patient presents with pain and swelling in his ankle following a basketball injury that occurred the previous day. Your FP diagnoses the patient with a closed bimalleolar ankle fracture and performs closed treatment without manipulation. Solution: You report 27808 (Closed treatment of bimalleolar ankle fracture [including Potts]; without manipulation) linked to 824.4 (Fracture of ankle; bimalleolar, closed). Opt for E/M and Casting in These Instances There are also several common instances in which you should not bill fracture care codes. The fracture care codes would not be appropriate if the following criteria apply: The fracture is old. There is a nonunion of the fracture. The fracture has healed or mostly healed. The FP is not providing a restorative treatment or procedure for which he is going to assume follow-up care for the next 90 days. The FP doesn't recommend follow-up visits. The FP refers the patient for a more extensive procedure, like open treatment with or without fixation. In the above cases, you should bill the appropriate E/M service, such as 99201-99215 (Office or other outpatient visit ...), with the appropriate casting and strapping application codes (29000-29590), where applicable, instead of a global fracture care code. Remember: When you code application of casts and strapping (29000-29590) and an E/M service, you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. Suppose your FP casts an established patient's finger after performing a [...]