Wiki Closed reduction w/o manipulation?

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ahodge90

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I am needing some help understanding when I should append a closed reduction w/o manipulation on a Greater Trochanter fx.
My physician reviewed xrays, and said that there was a stable Greater Trochanter fx, as well as a stable Superior and Inferior Rami Fx. He said he is going to treat these conservatively. He does not do anything to "stabilize" any of the fx's. He is going to have Physical Therapy to help the patient out. Also, he did not offer any crutches, etc, because the patient already has a power chair.
My doc wants to bill a fx care code here. I know he does not qualify for 27197 her but would he qualify for 27246 because of the therapy and having the patient follow up with him? Or would it be safer here because he really did not do anything to "stabilize" the fx's to only bill an e/m here?
Any help to understand this would be GREATLY appreciated!
 
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You have to understand "Fracture Care". Especially fracture care "without" manipulation. It would really be better to call it "Fracture Management". In fracture care without manipulation you are going to monitor & manage the fracture for about 90 days. The patient will need to return for X-rays multiple times to make sure the fracture is healing and is not lengthening or displacing. Your doctor has the right to bill a fracture care code, without manipulation, if the intention is to bring the patient back so your doctor can verify that it's healing, or not. Just because your doctor did not "do" something does not mean they are limited to just billing an E/M.
 
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This information was very helpful, thank you!
So just to make sure that I am understanding this correctly, based on what you say here, because my doc is planning on seeing the patient in the clinic for follow up, he can bill 27246 here, right?
Also, if my doc want to bill his consult with the fx care, is it appropriate to bill out an e/m with a fx care as long as he has everything to support the e/m or because everything is on the same note, it would be better to only bill out the fx care here?
 
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Suggestion: Don't use the word "Consultation" unless you are actually billing one. CMS & Most private insurance companies don't process claims with consultations any more since the codes submitted were inaccurate and did not meet the qualifications for an actual consultation. To answer your question, yes your physician can bill the appropriate E/M with fracture care. Another point since I see this all the time. Fracture care must be properly documented. Most physicians think that they can just tell their biller/coder to bill it out because that's what they want or it's just "implied". That does not support the code and all codes must be supported. They must put in their documentation that they are initiating fracture care. The statement that they will treat the fracture "conservatively" does not support the code because the provider could bill office visits and X-rays and that would be "conservative". If they want to bill fracture care, that decision must be documented in the medical record.
 
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