Wiki Fracture Care after being seen in ED

[gr8gal61]

I am sooooooooooooooo confused and need some expertise please. How is fracture aftercare coded? Ex; patient goes to ER/ED and is seen with left humerus simple supracondylar fx. The ED physician places a long arm, posterior splint, prescribes ibuprofen & refers to ortho physician. The code used in the ER was 812.41 plus the E&M code.

Patient goes into the Ortho for the first time, the code used was the same 812.41 & bills and NP E&M-25 along with long arm cast 29065.

The patient returns to the Ortho for a follow up, a week later, physician orders xrays, and removes cast & reapplies a new cast. Xray reveals no change in alignment with evidence of healing fracture. The doctor now uses dx 719.42 - left elbow joint pain. Charges an E&M, 992125-25 along with application of long arm cast, 29065.

Another follow up visit occurs a week later, same documentation as prior week except the Xray reveals no change in alignment with callus formation and evidence of healing. Same codes used, 99212-25, 29065 ICD9 719.42

I THOUGHT in order to bill for cast removal, application and supplies, V54.11 must be used???

What am I missing? I do not know if the E&M can be billed because of the Xray order but I don't believe both the application and E&M can be billed when the doctor is not using the V code????


HELP PLEASE

 

[mitchellde]

I am sooooooooooooooo confused and need some expertise please. How is fracture aftercare coded? Ex; patient goes to ER/ED and is seen with left humerus simple supracondylar fx. The ED physician places a long arm, posterior splint, prescribes ibuprofen & refers to ortho physician. The code used in the ER was 812.41 plus the E&M code.

Patient goes into the Ortho for the first time, the code used was the same 812.41 & bills and NP E&M-25 along with long arm cast 29065.

The patient returns to the Ortho for a follow up, a week later, physician orders xrays, and removes cast & reapplies a new cast. Xray reveals no change in alignment with evidence of healing fracture. The doctor now uses dx 719.42 - left elbow joint pain. Charges an E&M, 992125-25 along with application of long arm cast, 29065.

Another follow up visit occurs a week later, same documentation as prior week except the Xray reveals no change in alignment with callus formation and evidence of healing. Same codes used, 99212-25, 29065 ICD9 719.42

I THOUGHT in order to bill for cast removal, application and supplies, V54.11 must be used???

What am I missing? I do not know if the E&M can be billed because of the Xray order but I don't believe both the application and E&M can be billed when the doctor is not using the V code????


HELP PLEASE

The patient was treated in the ER with definitive treatment for the fracture. Since they did not use fracture care you can charge the E&M for the follow up. My he diagnosis however for the first ortho encounter is the V54 for healing fracture. Since the ER performed the definitive care then the fracture is now in a healing status. For the ortho to remove the cast and apply a new one is still aftercare, and for ICD-10 CM this will be subsequent with routine healing. It does not matter that you provider has not examined the patient before for the diagnosis. The diagnosis is the patients.the pain code would not be used at all unless the pain is documented as unusual or unexpected at this point in the healing process. You just use the V 54 code until healed.

 

[gr8gal61]

Thank you very much. Quite helpful.