Fracture care--time frame to bill

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Lexington, KY
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My Orthopaedic coders I need your help. If you have any documents that I could use for reference that would be great!!!

Patient presents to Ortho surgeon with a 4 week old healing fracture. The Ortho surgeon applied a cast in office with no manipulation for treatment of the fracture. Follow up scheduled for 3 weeks for fracture/cast check. The Ortho surgeon wants to bill fracture care for this.

My teaching with fracture care has been--it is typically billed within 7 to 10 days of the initial injury. My communication back to the provider suggested to him itemized billing (office visit, cast application, and casting supplies) would be more appropriate for this situation of the 4 week old healing fracture.

Any thoughts, help, or reference material? I appreciate everyone's help :)
 

KMCFADYEN

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Roanoke, VA
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My Orthopaedic coders I need your help. If you have any documents that I could use for reference that would be great!!!

Patient presents to Ortho surgeon with a 4 week old healing fracture. The Ortho surgeon applied a cast in office with no manipulation for treatment of the fracture. Follow up scheduled for 3 weeks for fracture/cast check. The Ortho surgeon wants to bill fracture care for this.

My teaching with fracture care has been--it is typically billed within 7 to 10 days of the initial injury. My communication back to the provider suggested to him itemized billing (office visit, cast application, and casting supplies) would be more appropriate for this situation of the 4 week old healing fracture.

Any thoughts, help, or reference material? I appreciate everyone's help :)

From wahmcoder 2/21/10

When Fracture Care Codes Apply
You are seeing the pt for the initial visit for the injury.
The injury is acute occurring within the last 2 weeks. One exception to this could be an undiagnosed scaphoid fracture which often takes longer to show up on the xrays
Patient has not had surgery for this injury by another physician in a different practice.
You plan to care for this fracture for the next 90 days.
If the pt was seen in the ED or by another physicians office and later sent to an ortho for fracture care confer with your physician regarding billing of fracture care. Generally with orthos the pt is seen initially in the ED then they are sent to an ortho these can still be billed out as fracture care codes.

You Shouldn't Bill Global Fracture Care
If the fracture is old.
If there is a non union of the fracture.
The fracture is healed or mostly healed.
Your doc isn't going to care for this fracture for the next 90 days.
No follow up appt are recommended.
Pt is scheduled for pinning or open treatment.

If the fracture doesn't meet the criteria for fracture case use the appropriate E/M fracture with casting or splinting codes with a mod 25.
 

amyjph

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Escanaba, MI
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Agree w/ you. It's too late if it's been 4 weeks since the initial fx. I would not bill fx care in this case. The E&M route, cast app, supplies would be the best route to take.

We run into something like this where the patient presents to the office for the initial visit right after the fx, but the provider is not certain they want to bill fx care so they bill an E&M; they have the pt come back in about 10 days to see if it displaces or not. They want to bill fx care on the second visit & in my opinion this is not fair to the pt so we do the E&M path on this one too.

I have not been able to find any real documentation about this. The AAOS site & Karen Zupko have some good pointers on it.
 
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