Fracture care for re-fracture


Cary, NC
Best answers
Hi everyone,

I wanted to get some additional opinions on this case I have been researching. Our ortho clinic had a child who fractured his wrist and saw our providers and we initiated a fracture care global period for him. He underwent two casting changes/checks and was okayed to be transitioned to a brace after the third cast removal; however the parents stated they found the same brace online for cheaper than what our practice quoted (they are uninsured) so he left without one. The parents were warned against any activity such running, sports, etc. until they received the brace and to continue the precautions for another couple of weeks after the brace was placed. The child went out the next day bicycling/fell and re-fractured the same bone. The coder is asking me about billing for fracture care again; however I feel like this might be double-dipping since we're still within the first global period for the same bone essentially and the physician only submitted an office visit charge. I don't feel like any modifiers would be appropriate either as it wasn't a return to OR, unrelated (since technically the same bone), and it wasn't anything staged.

Thank you


True Blue
Salt Lake City, UT
Best answers
If the fracture had displaced with normal body movement and no outside force or trauma it would be a different situation. Since there was another accident during the post-op period this is considered a "new injury'. So your fracture care can start again. Keep in mind that "returning to the operating room" is a CMS or Medicare requirement which this patient probably does not have. Frequently in these situations ORIF or percutaneous pinning is needed, but that is for your doctor to decide on a case by case basis.