Closed treatment of fractures

TPeniston61

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Does anyone know how to best explain closed treatment of fractures to patients? 1. They don't understand why it is listed as a surgery, and they insist they didn't have surgery. I try to explain that that is how many medical procedures are classified and that it doesn't have to involve an incision (how most people view surgeries). 2. They usually say that the doctor just examined them; he didn't do anything. 3. Usually, we bill an office visit for a new patient plus the treatment code. I know a closed treatment can involve range of motion testing, application of a splint, cast or strapping or manipulation of some kind, but sometimes it doesn't involve any of these. It only initiates a global period of treatment and monitoring of healing. Does someone have a better way to explain this so that patients can understand, and we can justify the cost?

Thanks,
Teri
 

RyanRaichCPC

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We ran into this a lot in our clinic as well. We actually began printing off a sheet for each patient that explains fracture care to them. The best things to point out to the patient would be that in billing out the closed tx of the fracture, the doctor has agreed to follow the patient's care until the global period has ended, meaning that all follow up visits are included in the cost of the closed tx of their fracture with exception of course to xrays and casting material/DME. Sometimes pointing out that this can actually be more cost-efficient in certain cases, makes the patient happier and able to understand this a bit better. Also just explaining that closed treatment of a fracture is not a surgical procedure, but closed treatment can mean several different things in the way the fracture is being managed. Does this help?
 

TPeniston61

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We ran into this a lot in our clinic as well. We actually began printing off a sheet for each patient that explains fracture care to them. The best things to point out to the patient would be that in billing out the closed tx of the fracture, the doctor has agreed to follow the patient's care until the global period has ended, meaning that all follow up visits are included in the cost of the closed tx of their fracture with exception of course to xrays and casting material/DME. Sometimes pointing out that this can actually be more cost-efficient in certain cases, makes the patient happier and able to understand this a bit better. Also just explaining that closed treatment of a fracture is not a surgical procedure, but closed treatment can mean several different things in the way the fracture is being managed. Does this help?
Yes, thank you. I might suggest that we develop an handout that we can give to our patients.
 

matt2374

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We run into this 2 or 3 times a week in our office. Best thing I have found it do straight up admit that you understand that you would not consider it surgery in a typical sense, however it does not go by whether it is surgery or not. The CPT book is broken up into many section like radiology, labs, e/m. There is also a section for surgery. Within this section the codes that are used to treat all fractures are located. To make it easy they normally put the codes in order of treatment without manipulation, treatment with manipulation, and typically ORIF of the fracture. The explanation of benefits received by the patient is not stating that the patient had surgery, rather instead of giving the code to the patient, the "surgery" that the EOB shows is just the section of the CPT book to which the code is located. That will usually stop the patient from thinking that they were charged for a surgery that they did not have.

From a cost justification standpoint it really depends on what your practice uses for a fee schedule. If you use something similar to FairHealth, depending on your zipcode, they are most likely going to be upset no matter what. Sometimes the best thing to say is that you do not determine the fee schedule. I have never seen a patient go to one of our doctor's and ask why they charge so much for this. They will ask billing staff yes, but never the doctor.

The toughest I have found is when the patient states "the patient just examined me, he didn't do anything" like you stated in your post. I just try explain to the patient that this is the code that is billed in order for the doctor to make a determination that it is in the best interest to not perform a "real surgery" or manipulation in order for the fracture to heal properly. If you are in network I would inform them that it is their insurance company, not you, that is determining that this is the going rate for this code. Just like we are not suppose to over code we are also not suppose to under code.

I have just come to accept that these phone calls are usually 10 - 20 minutes of torture. These calls always feel like a lose/lose whenever I get off the phone. Hope that helps a little bit though.
 

RyanRaichCPC

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I might also suggest, if you run into phone calls like Matt is referring to, I often tell the patient to reach out to their insurance company (as he suggested) if they are being difficult and not quite understanding. Oftentimes hearing that the service is billable and medically necessary from more than one source can help ease the patient's mind.
 
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