Fracture Care Issues

campy1961

Guru
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I have two fracture scenerios that have really stumped me!

First,
Pt fell on 12/24 and fractured her arm. Was seen in the ED, they reduced the fracture and is now being seen in our Ortho clinic. The ED visit was done at another hospital, so I don't know if they charged for the fracture or not. On our visit we did xrays, took off the old cast and put a short arm cast on and f/u in 1 week. Physician wants to charge 25600. Can we do that?

Second,
Patient went to the ED on 12/19 with a heel fracture. Was seen in the ED and was charged for ED visit and cast no fracture care charge. Fracture is heeling well and was put in a Cam Walker. Return in 4 weeks. Physician wants to charge 28400. I am thinking we can not charge for a fracture care????

Thanks for your input.
 

purplescarf23

Networker
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First scenario I would agree fracture care is billable. Provider is following the fracture through its healing process and requesting the patient come back and do x-rays to see the progress.

Second scenario do they state anything about doing x-rays? We would bill fracture care since the provider again is following the healing of the fracture. Pretty vague but from my understanding and what we do if the provider plans to follow the fracture during its healing stages then he/she can bill fracture care codes.

Hope that helps.

Kelsey, CPC
 

TMHales

New
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What if the doctor is not going to see the patient but for that one time. Do you still use the fracture care code? What about if he only will see the patient 2 times, still the fracture code?
 
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