Wiki 25600 documentation requirements

[jeburke23]

I'm in a disagreement with another coder on if this documentation meets the requirements. Our provider has stated that the patient had distal radial fracture and instructed the patient to continue brace w/ non weightbearing. Which they say is supportive of billing the 25600. When I read the CPT description this provided info doesn't seem like enough to support the billing, but I'm unable to find supporting material.

 

[NRaizman]

Unfortunately, the bar is low and this likely suffices.
It has a 90-day global.
This is as much as any ER does, and they bill the code with a -54 modifier 90% of the time.
The weakening of the fracture codes was a power play by ER docs to get more money, and they succeeded at CPT.

 

[amyjph]

Was it the first time they saw the patient for the fracture? Was it a scenario like the pt went to urgent care or the ED, got the brace, and then f/u with your provider already wearing it? What else was done/billed during the visit?

 

[jeburke23]

Was it the first time they saw the patient for the fracture? Was it a scenario like the pt went to urgent care or the ED, got the brace, and then f/u with your provider already wearing it? What else was done/billed during the visit?

PT was originally seen by PCP who referred them to Ortho. PT came to Ortho visit already in fracture brace and after evaluation with provider instructed the patient to continue brace w/ non weightbearing along with PDM.

 

[amyjph]

PT was originally seen by PCP who referred them to Ortho. PT came to Ortho visit already in fracture brace and after evaluation with provider instructed the patient to continue brace w/ non weightbearing along with PDM.

I see you said you are in disagreement with another coder. However, did anyone ask the provider what their intent was? Did they want to put the patient in a global and charge the non-op/non manipulative cpt, has anyone checked w/ them? Maybe they want to go itemized. Does the practice have a procedure to explain to patients/guarantors that this means they will be in a global "surgical" period. Because, when they get the EOB, and that big charge that many times has the words "surgery" on it, they are going to call and tell you no one had surgery. And be upset because it was not explained up front. Not saying the non-op fx code should not be used, I am just pointing out the repercussions of it. Especially if the provider's intent was not to use that route. What did the whole note/plan say? When will they come back in?

p.s. I lived in Hiawassee many years back Love your area!