Wiki Fracture care - derm coder

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hkatie

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I'm a derm coder and rarely work in the musculoskeletal section. I'm interested in 25600 (closed treatment of distal radial fracture without manipulation.) Ortho takes a detailed history, removes temporary splint, performs a problem focused exam, reviews x-ray and report from radiology, discusses the pros and cons of splinting vs casting materials with the family, and determines the patient needs a splint. The temporary splint is reapplied, a prescription is given for the splint ortho wants the patient to wear, and follow up is planned for 4 weeks. The splint is purchased at a DME provider by the patient and applied there.

Is the fracture care code still okay for this service?

Thanks in advance,

Katie

(I do not have a note as this was a family member's service. The code seems okay, but before the bill is paid we just want to be sure. It's a breathtaking bill.)
 
I would bill for the E/M service, the xray (if it was done/read in the office) and for fx care.
 
? It is my understanding that an E&M code can only be used in conjunction with the fracture care code if manipulation is done or a trip to the OR. (Maniupulation is considered a surgery) and the 57 modifier would apply with the E&M code to indicate that.
With that being said, the physician can bill either / or. Meaning they can bill with an E&M code for the first and each follow up visit, as long as the total does not exceed the amount of $ the fracture care code would of been.
The 90 day global package is what makes the fracture care appear so pricey, but you are paying for numerous follow up visits within that package... If billed per office visit, and you add them up ,it should be about the same as the fracture care cost. If I am incorrect, I would appreciate the update :)
As always, Xrays are not part of the global package (so you can bill for them) and if a cast is applied the first cast you can only bill for supplies. Subsequent casting can be billed for both supplies and application.
 
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I don't believe your statement is accurate excelortho...when using the global method, you code for the procedure, which invokes a 90-day global period. All subsequent E&M services related to the fracture are covered by the global fee as well as the application of the first cast or splint. The original E&M service may be coded with a modifier (such as 57 or 25), depending on the level of the encounter. If the encounter is minimal, which it may be for evaluation of an isolated injury, do not code for the encounter. As you stated, you can also bill for xrays because they are not part of the global package.
 
Im not sure where the accuracy of my statement is questioned, unless you are refering to the fact that I did not mention the 25 modifier.Taking into consideration the question that started this thread, I did not expound on that aspect billing. I am familiar with the post copied and pasted above from the Ortho forum as I have done a ton of research on this and have come to the conclusion that if the sole reason the Dr (Surgeon) is seeing the patient is strictly for the care of the fracture, I will not bill an E&M unless I am also using the 57 modifier indicating a decision for surgery. The start of this thread distinctly stated, that the"splint was removed","xrays were reviewed", and the "temp splint was reapplied". This indicates that a thorough eval was done in all likelyhood in the ER. A fracture if not diagnosed, was at least suspected,and this Dr is following up solely for that reason.
Per your own documentation above "If the encounter is minimal, which it may be for evaluation of an isolated injury, do not code for the encounter. " with that said, this should not be billed with an E&M. The encounter is only for an isolated injury.

Unless I am seeing a ton of documentation that a evaluation was completed to rule out or confirm other injuries , I do not feel comfortable billing for an E&M along with a fracture care code. I see you have excellent credentials, so I ask, does this make sense? :)
 
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E/M service and fracture care

excelortho said:
? It is my understanding that an E&M code can only be used in conjunction with the fracture care code if manipulation is done or a trip to the OR. (Maniupulation is considered a surgery) and the 57 modifier would apply with the E&M code to indicate that.
With that being said, the physician can bill either / or. Meaning they can bill with an E&M code for the first and each follow up visit, as long as the total does not exceed the amount of $ the fracture care code would of been.
The 90 day global package is what makes the fracture care appear so pricey, but you are paying for numerous follow up visits within that package... If billed per office visit, and you add them up ,it should be about the same as the fracture care cost. If I am incorrect, I would appreciate the update :)
As always, Xrays are not part of the global package (so you can bill for them) and if a cast is applied the first cast you can only bill for supplies. Subsequent casting can be billed for both supplies and application.
Click to expand...

What I was questioning is the statement "an E&M code can only be used in conjunction with the fracture care code if manipulation is done or a trip to the OR." That is not accurate as you can bill an E&M code with a -25 modifier if the visit warrants it. In the original post it said that the doctor took a detailed history, reviewed xrays, etc...so if I was the one coding it I would bill for the E&M, fx care and xrays. However, if the patient showed up with an already diagnosed fx and just needed to be splinted then I agree that I would not bill an E&M. My post was not meant to offend you but to clarify that there are times when an E&M is appropriate. :)
 
curoius

so ... to clarify
it is allowable to bill out an e/m level with fracture care if the doucmentation supports it.
correct?
some in my office are saying that fracture care includes the intital visit, excluding x-rays.
 
Not so sure about fx care

khanninen said:
I'm a derm coder and rarely work in the musculoskeletal section. I'm interested in 25600 (closed treatment of distal radial fracture without manipulation.) Ortho takes a detailed history, removes temporary splint, performs a problem focused exam, reviews x-ray and report from radiology, discusses the pros and cons of splinting vs casting materials with the family, and determines the patient needs a splint. The temporary splint is reapplied, a prescription is given for the splint ortho wants the patient to wear, and follow up is planned for 4 weeks. The splint is purchased at a DME provider by the patient and applied there.

Is the fracture care code still okay for this service?

Thanks in advance,

Katie

(I do not have a note as this was a family member's service. The code seems okay, but before the bill is paid we just want to be sure. It's a breathtaking bill.)
Click to expand...

Hi Katie,
As an orthopedic coder, our practice would not bill for fracture care when we send the patient out for an orthotic and it is fitted by another provider. When we bill fracture care, it is always for conditions where our providers apply the splint or cast whether it is molded or not.

Just a second or third opinion on the billing for your query.

Marilyn
 
cast application

Can someone please help??:confused::confused:
If an orthopedic dr does a fracture surgery and cant cast the patient that day due to the swelling or any other reason, can he bring the pt back to the offic, say a week later and charge a cast application code (29000 codes) and for supplies (Qcodes)? I know the casting is included at the time of surgery but I just need clearification becuase I am receiving different answers. Thanks:)
 
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