CR and ORIF on different encounters, Can I charge for both?

cbeuerlein

Contributor
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Our physician saw a patient in the ER for right comminuted displaced distal radius fracture with dorsal angulation and dorsal displacement of distal fracture fragment extending into the radiocarpal joint. The Physician preformed a CR distal radius. On the same day the physician determined an Open reduction was need. The open reduction was performed 4 days later. The physician believes he can charge for the CR because it was a different encounter. Can I charge for the CR even though the decision for the open was determined the same day as the CR?
The physician also wants some literature to support this?

Although the patient is not Medicare I did look at the NCCI edit guidelines and it only makes references to not charging if performed during the same encounter.

Plan
The patient really needs open reduction, internal fixation next week. I have discussed that with him. We went ahead and did a hematoma block on him today and did a gentle closed reduction. We reduced and cored the gross deformity of the wrist. We put him in a well molded sugar-tong splint. He does want to go home instead of being admitted.
We will plan to admit the patient to Same-Day Surgery to get his fracture fixed.

Thanks for you help.:)
 

judithdoss

Networker
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Oakbrook
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CR then ORIF 4 days later.

I do bill for both of these based on Medicare. I bill for the CR and then bill for the ORIF with a 58 modifier.

Judy
 

primrose1

Guru
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I would also like to find out if there is literature regarding this. I asked the same question a couple of weeks ago and got a couple of different answers.........any other thoughts and/or recommendations???
 
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