Fracture care vs non-fracture care

dballard2004

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We have an ortho gorup at one of our sites who has great confusion on billing fracture care vs non-fracture care (E/M). We have never found anything in writing but was finally given to understand that if the fracture was treated as a soft tissue injury, then don't use fracture care CPTs. Can anyone shed some light here, please? Thanks,
 

mbort

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In our ortho practice, if its a confirmed fracture, we code/bill for the fracture care.

I did a case study consisting of 10 different types of fractures for my guys and was able to prove to them that in the long run its in their best interest. I gave them the breakdown of both scenarios in $$$ and they agreed. In some cases there was significant difference and others not so much.

Hope this helps
Mary
 

Lisa Bledsoe

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What do you mean by "treated as a soft tissue injury"? If it is a fracture it obviously is not a soft tissue injury. However, as far as I know, you don't HAVE to code fracture care, you have the option of coding E/M visits. We sometimes do this with finger or toe fractures, but larger fractures we use the fracture care code as applicable.
Lisa
 
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If what you are referring to is a non-manipulative fx, then fx care should be reported when your physician is seeing the pt for initial consult for the said injury and is assuming care for the next 90 days.

Fracture care should not be reported when:
-Your doctor is not assuming care for the next 90 days
- Follow-up visits are not required
-The fracture is old / healed
-There is a nonunion of the fracture.
-Your doctor intends on bringing the pt to the OR for an extensive surgical procedure such as an ORIF, etc...

Have a good one!:)
 
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