Conflicting global frames

kenbeckman

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I would like some assistance with an unusual situation. Orthopedist saw patient with non-displaced radius-ulna fracture at wrist and billed with global code 25500. The patient returned two weeks later for followup and x-ray showed the fracture had slipped. Orthopedist did manipulation and casted the patient and billed with 25505, the global code for fracture care with manipulation. I do not believe he could bill two global codes in the same time frame for the same fracture, but also believe he should get paid more than the original global bill since that one did not include manipulation. Resubmitting the 25505 code for the first date of service is wrong since the fracture did not require manipulation at that time. I think the correct answer is that the provider should get paid for the 25505 on the second visit but the payment should be offset by what he received for 25500 at the first visit, but there is no coding for this? Opinion form ortho coders would be appreciated. Thanks
 
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I do not see an issue with billing for both. Your Dr assumed care for the fracture on the first visit, so billed 25500. Two weeks later, the second visit required a manipulation... this can be billed with a modifier 58 as it was a related procedure during the post op period.
 
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166
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Yakima, WA
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I agree with Patricia's answer above. This is actually a rather common scenario in orthopedic fracture care, and something you will see quite a bit. :)
 
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