Closed Fracture Treatment

ebkoralek

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Hello, All,

I am new to coding for ortho in the clinic setting and have a question regarding closed fracture care treatment. My doctor is seeing a patient for a right patella fracture and states that he is putting the patient in a hinged knee brace. He does not state anywhere in his documentation that he is supplying closed fracture care, but sent over the 27520 code.

I am wondering what this code constitutes? If he hadn't sent over the 27520 code, I would not have thought to code this for closed fracture care. Is there certain criteria that needs to be met in order to bill closed fracture care? If so what do the doctors need to put in their documentation?? I don't understand when I should or shouldn't bill for closed fracture treatment.

Any response would be appreciated!! Thanks!
 

Orthocoderpgu

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Fracture care needs to be documented

Keep mind that physicians see things through their point of view. Coders have to concerned with documentation and compliance because that is what we do.

Your doctor needs to document that he is initiating fracture care. This cannot be assumed. And just writing down the fracture care code does not support billing the code on its own.

If your physician is unwilling to state that they are initiating fracture care, then the code is not supported in documentation and cannot be billed.

As you coder your job is to verify and make sure that documentation supports every code billed to insurance.
 
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Re:

That code looks good to me. From my understanding that code is for the doctor to read the x-ray, examine the patient, and determine what is medically required to treat that patient It could be that nothing is required or it could be that they need to place a boot on the patient. Either way the doctor is using medical judgement to determine the best course of treatment for the patient. Just remember that code falls under 90 day global period. Alternatively you may use appropriate E/M code for visit and all subsequent visits relating to the fracture, however from re-reimbursement standpoint it is usually better to bill the closed treatment once.

Just be careful if the patient was seen in the ER before the office visit by a different physician. If have seen instances that the ER doctor bills for closed treatment then instructs the patient to follow up with an orthopedic. The patient then goes to a practice the ER doctor does not practice at and the new doctor will try to bill a closed treatment again. Insurance will usually deny this or try and re-coup money if they pay twice.

Hope that helps.
 

Orthocoderpgu

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code is good but documentatio does not support it

The CPT code may be correct, but the documentation, as is, does not support it.

If the doc says nothing but just writes down the code for fracture care, that does not support it. Especially if an office visit is being billed with it. The X-rays are a side bar and the physician is expected to do more work on multiple days in order to bill this code. So one days documentation and assessment does not support the code especially since there is no indication that the doc is going to follow the fracture after this date of service.
 

ebkoralek

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Thank you all for your responses. So from a couple of you, it seems that in order to bill closed fracture care the doctor needs to state that in his documentation? We also need to be sure that he is following up with the patient?
 

Orthocoderpgu

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Fracture care must be documented

Yes, fracture care must be documented.

It cannot be assumed, or otherwise interpreted by the coder.

The physician needs to state that he is either initiating fracture care or will follow the fracture non-operatively.

I cannot stress this enough, this needs to be documented. The physician just writing down the fracture care code for it to be billed is not enough. That does not support the code.

The documentation must support the code.
 

prayercoder

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NCCI Manual

This is what the NCCI Manual states:

The CPT codes for closed, percutaneous, or open treatment of fractures or dislocations include the application of casts, splints, or strapping. The CPT codes for casting/splinting/strapping shall not be reported separately.

If a physician treats a fracture, dislocation, or injury with an initial cast, strap, or splint and also assumes the follow-up care, the physician cannot report the casting/splinting/strapping CPT codes since these services are included in the fracture and/or dislocation CPT codes.

If a practitioner treats a fracture, dislocation, or injury with a cast, splint, or strap as an initial service without any other definitive procedure or treatment and only expects to perform the initial care, the physician may report an evaluation and management (E&M) service, a casting/splinting/ strapping CPT code, and a cast/splint/strap supply code

An evaluation and management (E&M) service, including emergency department E&M, may be reported with a casting/splinting/strapping CPT code if and only if the E&M service is significant and separately identifiable. Casting/splinting/strapping CPT codes are minor surgical procedures with a “000” global day period. Global surgery rules for minor surgical procedures do not allow a physician to report an E&M service related to deciding whether to perform a minor surgical procedure.
 
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