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Wiki Coding for Risk?

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lburgos31

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Has anyone heard of the idea of coding a CPT code which was not documented to cover the patient's and doctor's risk?

example: our doc saw a gunshot wound victim in the hospital. PT had a calcaneal fracture.

Bullet went through clean, no fragments, no surgery, no documentation of casting, just non-weightbearing.

Our doc coded a 28400.

Should we bill this even though casting was not documented?

My manager stated we should code this for risk purposes???
 
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Hi, I would have to say absolutely not. Knowingly submitting a claim for payment of an undocumented service is tantamount to fraud. I don't understand the premise that the physician should somehow be reimbursed for the "risk" of a surgery that they did not perform. Treatment of a fracture requires that the physician physically performs a restorative treatment to stabilize, protect or fixate the fracture. The provider can account for the severity of risk in calculating their level of E&M but I would not recommend reporting a CPT for fracture care.

I hope this helps :)
 
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