Wiki CPT 27760 with E&M

[krubino21]

What criteria do you use for billing an new patient E&M (99204-57) visit with CPT 27760 (Closed treatment of medial malleolus fracture; without manipulation-90 day global?)
We treated a patient for a left ankle fracture, he was seen at an outside ortho diagnosed and treated with a cam boot. He presents to us with pain that occurs when weight-bearing. We placed as short cast and will follow-up in 3 weeks.
Radiographic images were taken by the outside ortho and we reviewed them. We performed a History, PMH/FH/SH, ROS, and exam. Just because we performed the elements of the HPI/Exam and MDM does that justify the billing of the E&M?

 

[Orthocoderpgu]

Office visit and fracture care

Before any surgery, your physician will need to examine & diagnose the patient. This is true for fracture care as well. There is nothing stating that you can't bill both. However some clinics where I have worked bill either a new patient visit or fracture care.

The problem that I see in this specific situation is that another physician has treated the patient. So your in a global. You can still bill the office visit, but you may have a difficult time getting it paid. Same for fracture care if another physician has already billed for that. You can charge for changing the cast and the materials. Just remember to use -78 modifier on the casting code.

Had the patient not already been treated this would be easy to bill and get paid, but since someone has already billed for this, and you don't know exactly what charges they submitted, this could be fun getting paid.

Patient's think that the physician is getting paid for nothing when billing fracture care. But that's not true. The physician needs to make sure the bone is healing and still in place. Either one of these could mean a trip to the OR.