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Closed reduction

jmcpolin

True Blue
Messages
841
Location
Midvale, UT
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What documentation is needed in order to bill for closed reduction, if the patient has a fracture and the physician places patient in a sling is this enough to bill?
 

scooter1

Expert
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397
Location
Winter Springs, FL
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This is from a June 2002 Bulletin by Margie Vaught :

When deciding whether to code and bill a non-manipulative fracture service, one of the key issues should be provider intent. That intent may consist of the provider performing what he/she believes is more of an evaluation and management of a fracture and not so much a global fracture care service. Another issue in deciding whether to bill the fracture care global CPT code versus itemizing the services can be carrier-driven. Some carriers may require that an office bill for the fracture care code, if there is an appropriate CPT code.

In addition to carriers that require this type of billing, some insurance plans such as accident plans may also require this billing in order to have reimbursement provided for the patient. Each situation will be unique and different. Thus, the provider should be aware of the two options as outlined by the AAOS when it comes to non-manipulative fracture care coding. Practices will want to set up an internal policy that would allow providers to code each situation uniquely.

Below is a grid that can be used to help practices and/or providers understand what should be documented and required for the different methods:

Fracture Care Global Package

Need to apply:

Splint, cast, walking cast/boot, strapping, etc.

90-day treatment plan consisting of:

Restorative treatment or procedure
All postoperative visits
Initial application of cast or durable medical equipment (DME) device
Excludes:

X-rays
Replacement or subsequent casting and/or durable medical equipment (DME) device(s)
ALL supplies provided
Itemized Method

No restorative treatment or procedure is performed

ALL services billed separately:

All E/M services provided and documented
X-rays
Cast applications (initial and subsequent)
Supplies, including any braces, etc.
 
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