Wiki Billing Fracture Care

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Yes, I think it still is but I haven't researched greatly into it. Prior to 2022 it was. The new 2022 guideline revisions in CPT don't address this. For example, 23500 closed treatment of clavicle fracture w/o manipulation doesn't state anything in the description about having to be immobilized. The new guideline just states that casting, splinting, or strapping applied for comfort is not considered closed treatment.
It's convoluted and seems contradictory in places. In one spot the guidelines state the fracture and dislocation codes are categorized by type of treatment (closed, percuatneous, open) and type of stabilization (fixation, immoblization). This would lead one to think it has to be immobilized. However, the actual CPT descriptions don't say that for the closed treatment like the clavicle above. There are CPT Assistants that you can check out for reference too.



Please see here for some references. The question this one was different but the links will explain.

 
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I also think it is ok based on something I read in the 2022 NCCI Policy Manual, Chapter IV, page IV 12. It's talking about billing for multiple closed treatments without manipulation, but look at the green text (I didn't see how to highlight it, just turn it green) in the next-to-last paragraph. It's basically saying that the same rule applies even if you don't use a cast or strap, so that says to me that you can bill it without a cast / brace / strap.

16. If a single cast, strapping, or splint treats multiple closed fractures without manipulation, only one closed fracture treatment without manipulation CPT code may be reported.

Additionally, if a single cast, strapping, or splint treats multiple fractures without manipulation in addition to one or more fracture(s) with manipulation, a closed fracture without manipulation CPT code shall not be reported separately. These policies also apply to the closed treatment of multiple fractures not requiring application of a cast, strapping, or splint. Thus, if multiple closed fractures occur in an area that would have been treated with a single cast, strapping, or splint, only one CPT code for closed fracture treatment without manipulation may be reported.

If a cast, strapping, or splint applied after an open or percutaneous treatment of a fracture also treats a closed fracture without manipulation, a closed fracture without manipulation CPT code shall not be reported separately.

These principles also apply to the treatment of multiple dislocations or combinations of multiple closed fractures and dislocations. If multiple dislocations and/or fractures are treated without manipulation and stabilized with a single cast, strapping, or splint, only one CPT code for closed dislocation or fracture treatment (without manipulation) may be reported. Additionally, if a single cast, strapping, or splint treats any combination of closed dislocations and/or closed fractures without manipulation in addition to at least one closed dislocation or fracture that did require manipulation, only a single CPT code for closed treatment with manipulation of the dislocation or fracture may be reported.

Similarly, if multiple dislocations and/or fractures are treated with or without manipulation and do not require a cast, strapping, or splint, only one CPT code for closed dislocation or fracture treatment CPT code may be reported for the anatomic area that would have been treated by a single cast, strap, or splint.

Finally, if a cast, strapping, or splint applied after an open or percutaneous treatment of a dislocation and/or fracture also treats a closed dislocation and/or fracture that did not require manipulation, a CPT code for closed dislocation or fracture treatment (without manipulation) shall not be reported separate
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jghaddock said:
I also think it is ok based on something I read in the 2022 NCCI Policy Manual, Chapter IV, page IV 12. It's talking about billing for multiple closed treatments without manipulation, but look at the green text (I didn't see how to highlight it, just turn it green) in the next-to-last paragraph. It's basically saying that the same rule applies even if you don't use a cast or strap, so that says to me that you can bill it without a cast / brace / strap.
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Yes, I agree with you. I don't think the reporting of closed treatment (even with no immobilization) has changed from this perspective.
 
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