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Ankle Fracture: 2 sites

pvang

Networker
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Hi--

I have a question on the appropriateness of billing for two different sites of fracture on the right ankle. According the the xrays, the patient was diagnosed with an anterior talus and questionable medial malleolus frature of the right ankle. When this patient went in to see the doctor they billed 28430 (Closed treatment of talus fracture; without manipulation) and 27760 (Closed treatment of medial malleolus fracture; without manipulation). The phyiscian examined the ankle and placed it in a compression and a CAM walker and sent the patient home. Obviously the CAM walker was placed to stablized the two fractures on the right ankle, however, because the fracture happened in two different sites the treatment of the ankle was broken up and the patient was billed for each treatment of the frature sites.

Now I'm just wondering if this is appropriate?

Thanks in advance for your assistance!
 

pvang

Networker
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But by placing the ankle into a boot is one service. The physician isn't addressing one frature any different than if it was just one. By indiviudaling billing for the two fracture site when it's addressed by one service doesn't seem right to me though? More thoughts/guidance?
 

pvang

Networker
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I think this was how I should have phrased and asked the quesiton in the first place:

Patient went in to see the doctor for a follow up on her right ankle injury. The physician examined the ankle and the x-rays and his assessment of the injury was "Avulsion fracture of the right talus with possible medial malleolar fracture". The patient's ankle then was placed it in a compression stocking and into a CAM walker. The provider billed the diagnosis codes as 825.22 (Fracture of other tarsal and metatarsal bones, closed; navicular [scaphoid], foot) and 825.25 (Fracture of other tarsal and metatarsal bones, closed; metatarsal bone(s)) and the procedure codes as 27760 (Closed treatment of medial malleolus fracture; without manipulation) and 28430 (Closed treatment of talus fracture; without manipulation).

My first question is should the provider even code the "possible medial malleolar" fracture when it was never confirmed? Per coding guidelines, for an outpatient visit if the a diagnosis is documented as "probable", "suspected", "questionable", or other similar terms indicating an uncertainty, do not code but rather code the conditions to the highest degree of certainty for that encounter.

And secondly, since one of the diagnosis was probable only, service 27760 shouldn't be bill at all...correct? My thought is that by placing the ankle into a boot is one service/procedure. By billing the services individually according to the two fracture sites (one of them being a "possible" only) when they were both addressed by one service doesn't seem right to me.

Thank you so much again in advance for all your help!
 
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