Closed tx of tibial fx, w/o manipulation - 27530


Hendersonville, NC
Best answers
What kind of documentation is needed to support billing CPT 27530 vs. just an E/M code?

Example - If a patient with a cast goes to a physician and has an x-ray that confirms a proximal tibial fracture. The physician does not apply a cast, splint, boot, anything, but advises the patient to continue using the cane and come back if anything should change - would you bill 27530 because the patient has a fracture, or just an E/M? Are there any guidelines you know of or could provide with regards to these types of situations?

I need a little more info here. Was it the first time the md saw the pt? Who applied the cast? If casting was done in the ED, I would say code it as a fx chg and code the ov with a mod 57.
There was no cast - the patient came in with a compliant of lower leg pain, had x-ray which showed non-displaced fracture. Nothing was done - no cast, no boot, nothing. The physician told the patient to continue using her cane, basically take it easy and come back if there was any change. Would you bill fracture care or an E/M?

Let me know if you need any additional information. Thanks, Rena
I just got the WHOLE story, to help you in helping me. The physician is an orthopedic surgeon. The eldery patient, who uses a cane, is known to him, since on the first visit he billed an established patient E/M and ordered X-rays of her knee. One month later, the patient had an MRI which showed the old, non-displaced fracture of the proximal tibia (there were no additional visits between the initial visit/X-ray and the MRI). 1 week later after the MRI, the patient returns to the surgeon, who read the MRI, said you have an old fracture, I recommend just using your cane - no additional needs at this time - no casting, no strapping, no crutches, no W/C, nothing new - and that was the end of their encounter for this issue. For this visit, they did another knee x-ray. We're unsure as to whether to bill initial fracture care (27530) or another E/M?

At a local AAPC meeting yesterday, people were saying E/M. Your thoughts? Any coding references you can steer me to?

Thank you!