Fracture care and E/M coding

dgerry

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Albany, NY
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We generally do not bill an E&M service with a fracture care code. Most of the patients have been seen in the ER and have been diagnosed with a fracture and are seeing the ortho in follow-up. We bill fracture care global code for some fractures and E/M billed out with casting/splinting charges if the fracture is not going to be followed for most of the 90 global period. We have many issues with insurance companies not paying for fracture care that is not casted and/or manipulated. Any help would be greatly appreciated. Thanks!
 

armen

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We generally do not bill an E&M service with a fracture care code. Most of the patients have been seen in the ER and have been diagnosed with a fracture and are seeing the ortho in follow-up. We bill fracture care global code for some fractures and E/M billed out with casting/splinting charges if the fracture is not going to be followed for most of the 90 global period. We have many issues with insurance companies not paying for fracture care that is not casted and/or manipulated. Any help would be greatly appreciated. Thanks!
I work in ortho practice, billing fracture care almost daily. fracture care is not always about casting. for example toe fractures are not casted, we use strapping, so I dont see why insurance is denying. Email me aayrapetyan@perimeterortho.com lets look at some examples, maybe I can help.
 

susanb

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Serial Casting

If a patient is being treated for serial casting for Equinus deformity of foot. aquired, would you bill for an E&M service as well?
 
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armen

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Armen - thanks for your response. Do you bill E&M visits with fracture care at the same visit?
yes E/M -57 + fracture care + Q codes for cast supplies. After that all visits post op for 90 days, cast application code + Q codes + xRays.
 

armen

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If a patient is being treated for serial casting for Equinus deformity of foot. aquired, would you bill for an E&M service as well?
I would bill E/M only for the first visit with 25 or 57 modifier if modifier use if justified. and then all other visits only casting.
 
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