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Wiki Fracture care billing guidelines

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katie2011

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What is the appropriate time frame to bill out fracture care?

For example: Patient was seen by one of our PA’s on 8/4/23 and was diagnosed with fx and treated w/ splint (no fracture CPT code billed). Follow up scheduled with Doctor for 08/26/2023. At the visit with the DR on 8/26/23, almost 3 weeks later, is it ok to then bill out the fracture care? If not, Is there a time frame in between that is acceptable? Thank you for your help!!!
 
No. The fracture care (global) way of billing should have been decided on and billed at the intial visit. If the provider started out doing it the itemized (office visit E/M each visit) way they have to stay that way. They can't get the E/M first or for a couple visits and then decide later (almost one month...) to also go the global way.
Search fracture care, global fracture care, etc. in the forums for more info.

Question - New to Ortho Coding

ok bare with me.... Is there a fracture treatment code always coded when a patient comes in with a fracture (referring to initial only). The patient comes in with a fracture and a cast is applied (no manipulation or surgery) do I use a fracture care code (with no charge for casting of course...
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Think of it from the patient's point of view also. They had probably a co-pay, co-insurance or it went to deductible for a (example) 99203, and splint intially. They come back for follow up and now they are hit with a "surgery" CPT code which is going to have a larger fee and go to deductible (probably) or cost them more in co-insurance, but won't understand why this is now global while the 1st visit was an office visit.

I also used to run into this where the patient came in, the doctor maybe casted or splinted, did the E/M and had them come back to see if it shifted, then at the second visit maybe the next week they decide to charge them global fracture care, I wouldn't let them do it then either. It's not right in my opinion. Some others may have a different viewpoint.
 
I know it's a tough discussion. One I have had myself. I get why the provider wants to do it, it looks like more revenue and RVUs for them by reporting the 90 day code. However, if the provider reports the itemized method and the patient comes back to the office for their follow ups, usually it ends up being almost the same revenue at the end of the follow ups and treatment.
Look at it this way, who performed the "restorative" treatment? Not the doc that saw them almost a month later, the PA who saw them initially and applied the splint did. I don't think you're going to find a spelled out guideline or rule that says exactly what you are trying to convey to the provider. But, you could use the words definitive or restorative.

This article mentions those words.
In general: "Global fracture care" includes treating the fracture and providing any necessary follow-up care ("performing and accepting the care of restorative and follow up treatment of the fracture until healed").
In order to submit a claim for fracture care, the treatment must meet the definition of "restorative" care and must involve more than merely splinting the fracture after straightening the limb.
Some orthopedic groups don't report the closed treatment codes unless manipulation was performed. That's not a bad policy from my view. If your practice has internal customer service and A/R billing folks, ask them how many times they get angry patient calls about this issue where the patient sees "surgery" on their EOB and a big fee when, in their mind, they only went to the office and got a splint. It's always a sticking point unless there is a really good process in place where the patient is informed and understands what they are being billed/charged for.


Some other snafus come in if you are talking about your PA in the ED possibly seeing a patient, and splinting. In that case there are instructions on how this should be reported when it's ED vs. ortho. However, in your scenario way too much time has passed between the two dates. It would be more like the patient goes to the ED Sunday night, PA splints, and they follow up Monday afternoon w/ ortho. In that scenario you would probably expect to see a fracture care CPT from the ortho in the office.
 
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