Question Closed fracture care


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99222- Fee- $340.00 MCR allow- $135.88
99214- Fee- $263.00 MCR allow- $105.23
25565- Fee- $1715.00 MCR allow- $504.48(office), $457.18(facility)
73090- Fee- $79.00 MCR allow- $26.30

You see a patient on the floor who was involved in a MVA and sustained a both bone forearm fracture but no surgical intervention is required. You charge for 99222 and 25565. The patient has MCR and they pay for the Closed fracture treatment but they state the E/M is included you lose $135.88 for the E/M and you lose $43.30 on the closed fracture because you charged at another facility other that your office. When they follow up they will be in the global period and the only thing you will get paid for is xrays.(Reimbursement total- $483.48)

In the hospital you bill only the 99222 E/M code and you will be paid $135.88. When the patient follows up in the office they are considered a established patient so you bill 99214 with a 57 mod and 25565(Closd Tx). You will be reimbursed $105.23 for the the E/M and $504.48 plus xrays.(Reimbursement total- $771.89)

What is the correct process in billing Closed fx tx?


Longview, TX
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I've been billing 99222-57 with closed treatment in the hospital. The only time I don't do it that way is when the doctor states something like "we will treat him conservatively now and see him back in the office and reassess for a definitive plan". Then, if he decides to continue with closed care, charge the fracture care in the office.
We are also billing out casting/splinting w/58 modifier in the office, casting supplies and xrays.
I ran report to see if we are getting paid for the 99222, and it looks like the only time we don't is when it's closed treatment. We get paid when it's billed in conjunction with a surgery.