Wiki Coding for closed treatment of fractures

[Gayla1]

We recently added an ortho practice to our group and some of the physicians are billing doing an "itemized" reporting of the services for each patient encounter seperately. The physician reports each service independently and does not enter the 90 day global period.

We have always approached this by "Global" reporting of the services using the 90 day global fracture code with ot without the initial evaluation and management (E/M) service that has resulted in the decision for closed treatment.

I would like to hear from you ortho coders out there and if you have done any of the itemized billling and if so why you think or do not think this is a good way of reporting these services.

Also have you had any problems with insurance payors billing via the itemized method. We are based in New Mexico.

Thank you in advance for your help.

Gayla

 

[nyyankees]

We recently added an ortho practice to our group and some of the physicians are billing doing an "itemized" reporting of the services for each patient encounter seperately. The physician reports each service independently and does not enter the 90 day global period.

We have always approached this by "Global" reporting of the services using the 90 day global fracture code with ot without the initial evaluation and management (E/M) service that has resulted in the decision for closed treatment.

I would like to hear from you ortho coders out there and if you have done any of the itemized billling and if so why you think or do not think this is a good way of reporting these services.

Also have you had any problems with insurance payors billing via the itemized method. We are based in New Mexico.

.

Thank you in advance for your help.

Gayla

You can report fracture care with either the Global CPT (28540) or through a collection of E/M codes. Doc's choice

 

[dclark7]

The docs I code for use both methods. It usually depends on the location and severity of the fracture. For instance if they see a fracture of a finger, this may be coded as just an E/M if they only splint or buddy tape it, they may only need to see the patient one or two times after that. But, it the fracture looks more serious and could be more complicated then they charge the fracture code and have more follow-up.