explanation to patient for fracture care help

shellip

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??can anyone give me assistance on explaining "fracture care" to a patient that is told by her insurance co, she was charged for "surgery" and the patient is adamant she did not receive surgery--what she received was fracture care to the 4th toe while in office. I cannot get her past the word "surgery"--she feels that because she was not "in" suregery, she did not receive "surgery". I have explained all the care she received, but I cannot get her to listen. She continually states "I did NOT go to surgery".
HELP PLEASE!!!!
Thanks! Shelli
:eek:
 

RebeccaWoodward*

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I would try to explain that insurance companies require that we bill our services using a coding system known as CPT and that these codes are used to describe the service that are located in the "surgery" section of the CPT codebook. It does not imply that the patient had an operation, per se. This is merely the way the CPT book is organized for ease of use by both the insurance companies and physicians.

Maybe it will work...or not.
 

dmaec

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well, if you have a Coders Desk Reference book you could show it to her - or read the description to her:
28510 - The physician treats a fracture of one of the four toes other than the big toe. No open surgery or manipulation of the toe or foot is required. X-rays (reported separtely) of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physican applies a splint, brace, or cast to the toe and foot.

that's pretty clear ... even states "no open surgery"...
 

shellip

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thanks! crossing my fingers (and toes) she will actually listen to explanation. Thanks again!
 

becka95

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I have had this a lot from patients. I explain that although they didn't have surgery, they had fracture care performed by an orthopedic surgeon. In addition, the code is under the surgery section it is specifically stated in the description that it is a closed treatment not surgery. At the front of the section in the CPT book it states that closed treatment is a fracture site that is "not surgically opened"
 

Treetoad

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Also include in your explanation that this procedure has a 90-day global period. She will not be responsible for any charges related to the fracture care (unless, God forbid, she needs to go to the OR for a fracture related procedure or she needs a cast change). That may also help your case.
 
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