Wiki Closed Teatment Fracture Care w/o Manipulation

[volleyb13]

This is a pretty general question, I am new to this speciality, I need some help with the below scenario:

After sustaining a proximal humeral fracture, patient was seen in the hospital, x-rays taken to confirm fracture, & sling was applied in the hospital.

Patient now being seen in the office, Doctor re-examines the patient, states will treat fracture conservatively, and patient should continue in her sling, no manipulation is performed. Patient will follow up with office in 10 days for repeat x-rays to check for any displacement of her fracture.

My question is, can the doctor bill for closed treatment of proximal humeral fracture; without manipulation if he did not actually apply the sling & only agreed with the plan of care done in the hospital?

Any info/help that could be provided would be great!! Thanks so much!!

 

[Donna T]

The ER doctor should be billing for an ED visit and a splint application so your doctor has the choice of how he wants to bill. He can either bill "Global” reporting of the services by using the 90-day, global fracture code or “Itemized” reporting of the services by reporting each patient encounter separately. The physician reports each service independently and does not enter into a 90-day global period. Hope that is helpful to you.

 

[volleyb13]

That makes sence, just was not sure if the doctor in the office did not actually apply the sling, that it would still be okay to bill the 23600. Thank you very much for your reply.

 

[Billingandcoding2]

A decade later, how do you feel about this answer now? If you're still in orthopedics, do you still feel your physician can bill 23600 with no additional treatment? How about if they did not even put the sling back on and stated to use as needed? If so, would you also bill the OV+57?

 

[CBLENNIE]

A decade later, how do you feel about this answer now? If you're still in orthopedics, do you still feel your physician can bill 23600 with no additional treatment? How about if they did not even put the sling back on and stated to use as needed? If so, would you also bill the OV+57?

I know that you are asking the previous poster what their position is on billing the 23600 without actually providing additional treatment after 10 years (probably because of the major coding changes in the last decade) but I am going to weigh in on this question.

Working for a commercial insurance company if the medical record doesn't support that the ortho specialist did anything to actually treat the fracture, i.e., they didn't apply the sling after examining the patient, we would not cover the global billing of 23600 since they did not perform the initial procedure for treatment of the fracture as this was done by the ED provider. If there was ongoing post-op care provided by the ortho specialist that meets the criteria for billing 23600, we might cover the post-op portion of 23600 if the provider billed modifier 55 with 23600 and the documentation supports that the provider provided treatment for the full post-op period.

However, that is going to require that the provider saw the patient more than just this one visit listed by the OP. If the provider only saw the patient for this fracture one time, then they would likely be able to bill an E&M procedure. However, modifier 57-Decision for Surgery would not be appropriate since the surgery, 23600, was already performed by the ED physician and there was no surgery considered by the ortho specialist in the OPs original post.

 

[amyjph]

Resurrecting an old post! LoL

Would also add, there has been so much discussion about fracture care and this topic. I would also suggest searching the forums for more recent discussions on this, there are so many with good info.