E/M and fracture care code

eguest

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One of my physicians is stating a new patient E/M code is not appropriate to bill with a fracture care code. I have always heard they are billable together w/modifier 57 on E/M code. What is the rule? thx
EG
 

aklein

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It is billiable - Some insurances may not pay for an E&M on the same day as a procedure. Modifier -57 states "An E&M service that resulted in the initial decision to perform the surgery may be identified by adding -57 to the appropriate level of E&M service". Hope this helps!
 
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Bella Cullen

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One of my physicians is stating a new patient E/M code is not appropriate to bill with a fracture care code. I have always heard they are billable together w/modifier 57 on E/M code. What is the rule? thx
EG
Yes it is billable, and yes, you add 57 mod on the E/M code with any procedure code that carries a 90 day global. So in this case a fracture care code, which all fx care codes that I know of carry a 90 day global period.
 

cpccpma

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Just be sure your documentation supports the E&M code and the fx code. Also some payers want a 25 even though the fx code carries a 90 day global. You know how those crazy payer rules are sometimes. :)
 
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