Wiki Fracture care for multiple fractures

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Hello, I am looking for advice/opinions from other ortho groups regarding on how they handle fracture care billing for multiple fractures treated with the same cast. An example that I have now is a distal radius/ulnar fractures along with a humeral lateral condyle fracture both on the same arm treated with a long-arm cast. Since there is not a bundled code for these two would you bill fracture care for both or just one? We are trying to get an idea of what others are doing to come to a decision to be consistent in our billing. I understand that both would be allowed per the CPT guidelines and the payers would differ on their treatment of them; however they are also concerned about the financial burden this may create for families (peds practice) as more and more seem to have high deductible plans. Thank you!
 
I've always handled these types of situations as follows: if the provider is specifically documenting the closed reduction of each of the fractures then I code for the closed treatment with manipulation of each of the fractures (25605 and 24577 in your example). However, if he states he only reduced the radius/ulnar but the humeral lateral condyle was stable and would be treated with casting then I would only code for the radius/ulnar reduction and not bill anything for the humerus. The initial casting is included in the fracture care code and since both fractures are being treated with one cast I don't feel that it would be appropriate to code for the closed treatment without manipulation of the humerus (24576). The same would apply if no manipulation was performed for either of the fractures and only casting was done. I would only code the highest RVU procedure (25600) and not the other procedure since one cast is being used to treat multiple fractures.

Another user on AAPC posted a similar question and a different user answered with the NCCI edit policy which states when multiple fractures are being treated with the same cast then only the highest RVU would be billed. However, K Zupko posted an article stating it really depends on the payer because billing/not billing for the additional fracture treatment is correct/incorrect depending on your payer and the rules they follow.

I'd really like it if other ortho coders would chime in on how they handle these types on situations.

 
Set_Apart said:
I've always handled these types of situations as follows: if the provider is specifically documenting the closed reduction of each of the fractures then I code for the closed treatment with manipulation of each of the fractures (25605 and 24577 in your example). However, if he states he only reduced the radius/ulnar but the humeral lateral condyle was stable and would be treated with casting then I would only code for the radius/ulnar reduction and not bill anything for the humerus. The initial casting is included in the fracture care code and since both fractures are being treated with one cast I don't feel that it would be appropriate to code for the closed treatment without manipulation of the humerus (24576). The same would apply if no manipulation was performed for either of the fractures and only casting was done. I would only code the highest RVU procedure (25600) and not the other procedure since one cast is being used to treat multiple fractures.

Another user on AAPC posted a similar question and a different user answered with the NCCI edit policy which states when multiple fractures are being treated with the same cast then only the highest RVU would be billed. However, K Zupko posted an article stating it really depends on the payer because billing/not billing for the additional fracture treatment is correct/incorrect depending on your payer and the rules they follow.

I'd really like it if other ortho coders would chime in on how they handle these types on situations.

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Thank you very much for sharing! I'm meeting with them next week and we are going to review fracture care coding and this is one of their "hot topics" in this area in addition to overwrapping bi-valved cast or splints to convert to a closed cast post surgery/reduction. If you have any advice/opinions on that I would welcome those too!
 
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