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ED Billing for fracture care - PLEASE?????
I have two scenarios where I believe the ED may be incorrectly billing for fracture care:
#1 - Patient is seen with trimalleolar ankle fracture. ED provider attempts reduction which fails. Orthopedist is called in for consult and reduces the fracture; patient is to followup follows up for more definitive surgical treatment of the fracture two days later. The other issue is that I cannot find documentation in the ER record that the ED provider attempted a reduction; this information was gleaned from a discussion with another coder, but no documentation was provided. Fracture care 27818 was billed by/for the ER provider with a modifier 52?.
#2 - Different patient, seen with medial malleolar fracture; patient is sedated so ER provider can remove the patient's ski boot, and he places a splint while the patient is still sedated. Patient sees Orthopedist two days later for more definitive surgical treatment planning. ER provider charges CPT 27760. THis time, the sedation is documented and so is the removal of the boot and placement of the splint.
What is the appropriate way to charge both of these scenarios.
As I read the January 2015 article by Samson Kumaraswamy, BPT, MSc, CPC, CEDC, in neither circumstance is it appropriate for the ED to bill fracture care? Am I interpreting this correctly in these two situations.
Thank you very much in advance for any guidance on this issue.
I have two scenarios where I believe the ED may be incorrectly billing for fracture care:
#1 - Patient is seen with trimalleolar ankle fracture. ED provider attempts reduction which fails. Orthopedist is called in for consult and reduces the fracture; patient is to followup follows up for more definitive surgical treatment of the fracture two days later. The other issue is that I cannot find documentation in the ER record that the ED provider attempted a reduction; this information was gleaned from a discussion with another coder, but no documentation was provided. Fracture care 27818 was billed by/for the ER provider with a modifier 52?.
#2 - Different patient, seen with medial malleolar fracture; patient is sedated so ER provider can remove the patient's ski boot, and he places a splint while the patient is still sedated. Patient sees Orthopedist two days later for more definitive surgical treatment planning. ER provider charges CPT 27760. THis time, the sedation is documented and so is the removal of the boot and placement of the splint.
What is the appropriate way to charge both of these scenarios.
As I read the January 2015 article by Samson Kumaraswamy, BPT, MSc, CPC, CEDC, in neither circumstance is it appropriate for the ED to bill fracture care? Am I interpreting this correctly in these two situations.
Thank you very much in advance for any guidance on this issue.
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