Wiki Fracture care vs. E/M

[austinpete10]

I get a little confused on when to bill out a fracture care code vs. E/M's or if both should be used, this example is for the clinic pro-fee. Curious if I could get some insight on how others would code this case:

Patient comes into the clinic and is evaluated, and after x-rays is diagnosed with a radial fracture. The provider applies a short arm cast (no manipulation), and requests that the patient return in 3 weeks for another set of x-rays.
The patient returns after 3 weeks, the x-ray shows a healing fracture, and decides the cast can come off- and sends the patient home in a pre-fab splint. He asks her to return again in 3 weeks. Would you use a fracture care code, for the first visit or just an e/m w/the application of the short arm splint (29125). All follow-up is w/ the same provider in the same clinic. Thanks for any help! I just want to make sure I am understanding these types of encounters!


Jackie CPC, CEMC, CPMA

 

[mitchellde]

For fractures that require no manipulation/reduction you can code either as fracture care or as what is referred to as alternative fracture care.
alternative fracture care is billing an E&M with the casting and then billing each office visit when the patient returns for follow up.
fracture care is using the appropriate fracture care code and then no more billing for office visits for the follow up visits up to 90 days.
you get to chose.

 

[austinpete10]

Thanks for the reply! I do understand this part. I probably should have phrased that better- What I am curious about is, would it be most appropriate to bill out a fracture care code during the first encounter, knowing that the provider is having the patient return for follow up care. Generally in our practice, the patient is sent on to larger facility for fracture care, so we don't charge a fracture care code (generally e/m and splint). But, in this situation the provider didn't send the patient on, and is having them return. So, I was trying to find out if billing out the fracture care at the initial encounter would have been better, and a 99024 for the next 2 encounters. Now, the patient will have 3 separate office visit charges for all the follow up for a simple fracture.... Thanks for your help!