1. K

    Wiki Splint application by MA/RT -- billing question

    If a MA or RT applies a splint, and the provider is in the clinic for needed supervision but does NOT personally apply the splint, can we bill the splint application code set? Particularly, per Medicare guidelines. (Sources to support your opinion?) Thank you!
  2. J

    Wiki E/M Risk billing

    We saw a patient for f/u on a fracture. The cast was removed, but he fitted her with a material splint along with the counseling that goes with it. Also, did an order for x-ray. Would this be a 99213 or 99212? I am confused what the risk element would be for splint fitting and fracture f/u...
  3. D

    Wiki 28470

    Provider billed 28470 diagnosis: M84.374A After appealing with chart notes, UHC says that the chart notes do not support that the 28470 was preformed. Dispensal of pneumatic cam walker was documented and diagnostics were preformed to accurately diagnose the fracture. The initiation...
  4. D

    Wiki 28470 not preformed

    Provider billed 28470x2 diagnosis: M84.374A After appealing with chart notes, UHC says that the chart notes do not support that the 28470 was preformed. Dispensal of pneumatic cam walker was documented and diagnostics were preformed to accurately diagnose the fracture. All of this information...
  5. ahalle

    Wiki Fracture treatment - new or non-union?

    So I'm confused on this one. The Doctor is treating patient for the first time but patient has a non-union and a new fracture on the same bone. Debating between 25405 or 25545 for the procedure and whether Dx should be the S52.262A as he lists it or should be split into two seperate Dx for the...
  6. J

    Wiki 2nd Opinion, fracture, can we bill Office Visit?

    If someone could PLEASE shed some light on this because there are differing opinions in the office. A child was seen by a different practice, he has a broken arm, I am ASSUMING they billed a fracture code. Mom wants him to come see us for a second opinion because they are removing the cast...
  7. J

    Wiki Billing closed treatment of Vertebral Body fractures?

    An orthopedic doctor at my practice is wanting to bill 22310 for vertebral body fractures. This code requires bracing - he is wondering if we can still bill this code if we write the patient a script for a brace instead of doing it in the office ourselves. Note: If we did do it in the office -...
  8. S

    Wiki Fracture and dislocation treatment

    Does anyone know if we can code a closed reduction of both a fracture AND dislocation at the same site? It looks like the codes I am considering are not bundled, but I'm still not sure if it is technically correct to report both... The doctor dictated a closed reduction and percutaneous...
  9. S

    Wiki Closed Reduction Thumb Fracture

    Hi everyone! Can anyone help me code for a closed reduction and percutaneous pinning of intra-articular proximal phalanx fracture of the thumb? The two codes I am looking at are 26727 and 26742. I can't decide which one is right because 26727 specifies proximal phalanx, while 26742 specifies...
  10. J

    Wiki Fracture Manipulation and Surgery

    we had a patient with a displaced distal phalanx fracture which was manipulated in the office and then scheduled for surgery for the next week. can we bill for the manipulation or just the ov/xr/splinting?
  11. B

    Wiki Surgery Coding Question-Fractures and Fixators

    I am trying to code this op report and I think I'm trying to make this too hard. Can someone please assist? I thinking 11012x2 for the open fracture debridement and 20693 for the removal and reapplication of the external fixator? PRE-OP DIAGNOSIS: Open fractures right distal radius and distal...
  12. L

    Wiki Single fracture extending through 2 anatomic sites

    Patient has a closed fracture that extends from the tibial shaft through the tibial pilon. Is it wrong to code for both the tibial shaft reduction and the pilon reduction? The fracture spans 2 separate anatomic sites, but it is 1 continuous fracture. Is there any documentation on this? Thank...
  13. F

    Wiki Second fracture during global

    Please help.....I have two patients with essentially the same procedures. Patient had hemiarthroplasty for femur neck fracture (27236). Two weeks later, patient falls and has greater trochanteric fracture. Procedure performed "ORIF greater trochanteric fracture with revision of...
  14. A

    Wiki 76000 vs 77002

    I work in a plastic/reconstructive surgeons office and we do a lot of hand/wrist work including injections. Something I am seeing a lot of is the use of 77002 and 76000. My understanding of the descriptions of each is that 76000 is to be used for more extensive imagining i.e. confirmation of...
  15. A

    Wiki T12 fracture

    So this case has me going back and forth on which way to code it! The patient is in the hospital due to a fall. They discover a T12 compression fracture that "could be acute." They state in documentation "Fall/t12 compression fracture" but other then the way stated above it never confirms that...
  16. A

    Wiki Ramus Fx

    Hi guys! I think I might just be overthinking this for some reason. What is the correct code for superior inferior pubic ramus fracture? Would it just be the unspecified code or would it be both the superior and the other specified? Thanks!
  17. E

    Wiki Dental: Open vs Closed Fracture of Tooth

    Can someone please explain the difference between Open vs Closed Fracture of a Tooth? I am looking for an overall answer but my example for today is... "front incisors broken to the gum-line with caries" Thanks in advance!
  18. B

    Wiki Fracture care--time frame to bill

    My Orthopaedic coders I need your help. If you have any documents that I could use for reference that would be great!!! Patient presents to Ortho surgeon with a 4 week old healing fracture. The Ortho surgeon applied a cast in office with no manipulation for treatment of the fracture. Follow...
  19. S

    Wiki Multiple same site x-rays for pre and post reduction of fractures/dislocations

    We are having a hard time deciding how to bill for these types of procedures. It is multiples of the exact same study, i.e. shoulder x-ray for a dislocation, the first study to see the problem, and the second/subsequent to make sure it is set correctly. My first question is, since these are all...
  20. P

    Wiki Strains, Sprains and Splints in the ED

    Hello All, Just curious what your thoughts are for a patient who is diagnosed with a sprain or strain and given a splint. I am getting different information so I wanted to get some feedback. This is for Emergency Room Visits. Some say we ONLY charge a splint if the patient is diagnosed...
  21. T

    Wiki Fracture care - ATV accident

    Hi there! I have a billing question.. Patient came into our office after a ATV accident. He did not go the ER or anywhere else. The Patient Hurt is left arm Dr noted a Distal radial fracture nondisplaced. He did put a Don joy cast on his wrist but the Patient had to be sent out for Xrays since...
  22. C

    Wiki PIP fracture Dislocation Surgery report help

    Please help advise me on this procedure. My physician likes to review his surgery coding before they get submitted to insurance and approved the codes billed out. He does this procedrue quite frequently and we always use 26535, Same diagnosis, same procedure. He is now wanting me to use 26746...
  23. M

    Wiki Fracture Care followup specifics

    I've clashed w/my boss on the specifics of whether or not followup X-rays are included in the followup 90 day global for this radius w/ulnar fracture w/closed treatment, I'm using code 25560, no manipulation, with casting. Need to know if the followup x-rays can be billed separately (please...
  24. B

    Wiki Fracture - regarding this code

    Hello, I am a new biller and have a question regarding this code: 28510. I have a case where we billed this code along with 99203 for the initial office visit. The office visit is getting denied due to the fracture code. I did not think this should be an issue since it is the initial office...
  25. N

    Wiki Application of casts and strapping

    We have a situation that has created quite a debate in our office that we could use some advice on. Here's the scenario: a patient presents to the clinic with a fracture. The physician evaluates the patient and stabilizes the fracture with casting or splinting prior to surgery at a local...
  26. C

    Wiki Fracture care documentation

    My physician diagnosed a fracture however all he indicated on his report that the patient is to wear a locking knee hinged brace at all times is required and he wants to bill fracture care. Can anyone guide me to more documentation so that I can educate my provider? I know the AAOS is a huge...
  27. P

    Wiki Compression of spine help

    I am looking for clarification of what or if i can code a diagnosis - compression of t12 and l1 (it will be different locations in the spine). The documenation doesn't say fracture so i am not sure what this is....i was thinking i just don't have enough info however i am seeing this wording all...
  28. T

    Wiki level 2 or 3??

    I am only getting a level 2 out of this??? what are everyone's thought of this?? am I missing something to make it a level 3??? I only see 3 elements on the hpi I got expanded HISTORY complete ros I got a DETAILED EXAM complete pfsh...
  29. S

    Wiki Fracture Care

    One of my doctor's saw a patient in the office for a suspected fracture. In his note he diagnosed her with a left supracondylar fracture. He decided to treat this nonoperatively and planned to see the patient back in a week. I charged out fracture care for a closed treatment of a supracondylar...
  30. J

    Wiki Manipulation of previous fracture and re-casting in the office

    My Ortho billed the global codes for fracture care without manipulation for a patient who had a tib-fib fracture. The patient presented to the office for a follow-up visit with a complaint that the cast was too tight and bothering her. He removed the cast and x-rays show that the fracture site...
  31. T

    Wiki Orthopedic Diagnosis coding for Compression Fractures

    We need some guidance, and we also need to know how the choice of codes affects reimbursement. It is very difficult on our older patients with vertebral compression fractures to decide whether they have pathological fractures due to osteoporosis or traumatic fractures. In many cases, the...
  32. M

    Wiki Billing 27792 with 27829

    I have an Op report that states Fracture-dislocation Right ankle- "the fracture was exposed by sharp dissection and reduced manually." Later it states a plate was then applied to the posterolateral edge of the fibula and fixed with 5 cortical screws. Then goes on to state that the anterior...
  33. S

    Wiki Hardware removal after fracture

    Just verifying one more time! If patient is having hardware from ORIF removed, I'm just going to use Z47.2 and no fracture code, right? Patient is not having complications or pain. Thanks!
  34. S

    Wiki Orthopedic Fracture table 7th character

    If our orthopedic surgeon sees a patient in the office for consultation for a fracture (for example...S82.61XA). I would use the 7th character 'A' for the initial encounter. What would I use for a follow up visit after a CT scan? And what would I use for the surgery? I understand 'A' is only...
  35. C

    Wiki Open McLaughlin procedure

    Open McLaughlin/ shoulder procedure Can anyone shed some light on CPT code for this procedure? Thanks! PROCEDURE: Operation performed: Open left mclauglin procedure with biceps tenodesis DX: Left shoulder posterior dislocation with large reverse Hill-sachs lesion and lesser tuberosity fracture
  36. Z

    Wiki ICD-10 Code Fibula Fracture NOS

    Is there an ICD-10 code for a fibula fracture NOS?
  37. L

    Wiki Help please! CPT 27508

    If anyone could please give me some direction on CPT 27508, (Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation). What does "closed treatment" entail? I can't find clear information to describe what closed treatment without manipulation includes...
  38. L

    Wiki Multiple fractures - Can anyone help me on this one

    Hello, I have one where on 10/12/15 patient comes into the office for a 1. displaced metaphyseal fracture of right distal radius and ulna 2. mildly angulated closed left midshaft clavicle fracture Treatment Plan: Taken to Operation Room and had a closed reduction and percutaneous pinning...
  39. R

    Wiki fractures

    Is there a specific code for a Tufts Fracture of toe?
  40. C

    Wiki Surgery for malunion of fracture

    Procedure is ORIF of extra-articular distal radius ( 25607) Diagnosis is right comminuted distal radius fracture with partial malunion. I am still unsure how to code for these, when pt is getting surgery. According to the fracture coding guidelines, all diagnosis for surgery should be coded...
  41. D

    Wiki fracture

    person who has a fracture was diagnosed with S32.2XXA and fell at home. This was the only code reported. She was seen in the ER and then came to see her physician. How would this be coded? Would this be initial encounter or subsequent? Could this be a primary code along with the place of injury?
  42. L

    Wiki Ankle Fracture with Sprain

    Hello, Just wanted to see what is the proper way to code the following: Patient fractures medical malleolus and has an ankle sprain (both occurred at the same time, same ankle). Would code everything under the fracture care or would you code the fracture under a fracture care code and the...
  43. T

    Wiki Hardware pain with healed fracture

    I had a patient come back to clinic 10 months after ankle fracture with pain. The fracture is now healed and the Dr. dx the patient with hardware pain. Question do I code T84.84xA (initial hardware pain) and S82.841S (Bimal ankle fx that was the cause of the hardware)? Or do I just code the...
  44. D

    Wiki Radius Fracture

    We saw a patient who was in the ER where they reduced his radius. When he came into our office the radius was still displaced. The dr had to do a post reduction. Is this billed separately or part of the fracture care? thanks :-)
  45. L

    Wiki Fracture

    Hello, I have one where the patient was seen in the hospital as a consult on 11/3/15 for a distal fibula fracture by our doctor. Then on 11/16/15 the patient comes to the office for a fallow up on that fracture, first time we have seen them in our office. The hospital did not code a...
  46. P


    Need help please...does anyone have a direction for me for a fibular neck fracture? There is no tibia involved and I'm not finding a code.
  47. T

    Wiki Closed fracture

    I need help with billing fracture care. We had to send a Patient out for Xrays on his wrist. But our doctor believes that it is an acute closed fracture likely some displacement. I don't have a clue what to bill?? Any help would be great. Tracy
  48. K

    Wiki Coding for Closed Treatment distal radius

    Hi, Doctor dictates the following: The distal radius was reduced by closed manipulation under c-arm fluoroscopy control. The fracture was stabilized with 2 percutaneous 2.0 mm K-wires, 1 through the radial styloid and 1 through listers tubercle. K-wires were cut off outside the skin. Pin...
  49. M

    Wiki Distal radial fracture 25609 but missing something ?????

    25609-LT ?? DX 813.42 I feel as if I am missing something in this op report?????? Open reduction internal fixation of left distal radius fracture with fixation of greater than 3 intra-articular fragments. Instrumentation utilized: Stryker distal radius locking plate. Anesthesia: General...
  50. S

    Wiki Please advise......

    I need help with an orthopedic surgery. Please advise if the following codes are appropriate for the operative note listed: 24579, 25607-51, 64721-51 PREOPERATIVE DIAGNOSIS: Fractured distal right radius (extraarticular), and fracture of anterior aspect of trochlea of right elbow. PROPOSED...