Wiki 26740 Is this right? My son was seen at dr - Small avulsion fracture by the knuckle

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sherryjean27

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My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

Thanks,
Sherry, CPC
 
sherryjean27 said:
My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

Thanks,
Sherry, CPC
Click to expand...

Hello,
Yes dr can bill for fracture care 26740.
According to CPT guidelines, fracture care is billed as a packaged service. This means that at the time of initial care, a bill is generated that includes:
1. Evaluation of the fracture
2. The first cast or splint application
3. 90 days of normal, uncomplicated, follow-up care.
 
I believe that using 99070 for the strapping and an appropriate E/M code would have been more appropriate based on the information you give and the information in the CPT book page 139, next to last paragraph (if no other procedure was performed.)
 
sherryjean27 said:
My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

Thanks,
Sherry, CPC
Click to expand...

Unfortunately, the physician can bill for fracture care...but not for any f/u visits for 90 days. Personally, I have an issue with finger and toe fracture care codes when the fractures are so benign. But technically, these can be billed. Be thankful that your son didn't have more than one fractured finger, because the description of this code states "each", so you could have been charged for each finger!
 
I agree with Lisa - technically fracture care can be billed for. Our physicians don't generally bill for that with fingers and toes though unless significant intervention is involved as it seems unreasonable to bill such a high fee for such a simple treatment. I would probably discuss it with the physician if you follow up.
 
I would agree that a general ortho would probably disagree w/ coding the fracture code, but if you asked an ortho w/ subspecialty in hand, they would most likely agree with the global fracture care coding. There is much more to the hand w/ all the tiny nerves, vessels, muscles than what we sometimes think of. If we lost ROM or had residual nerve damage after a finger fracture, we wouldn't feel it was so minor.
 
So one could use 26740 instead of the general E/M with a 25 modifier and a fracture cast/splint?

Peace
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