Fracture care without fracture diagnosis

fltbaroque

Networker
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Longview, TX
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Frequently, our providers will charge fracture care when there is "no definitive fracture seen" or "possible fracture". They may send the patient for an MRI to verify the fracture. Am I correct in assuming that fracture care should NOT be charged unless they are SURE it's a fracture??
Also, if the patient is sent for an MRI and they do indeed have a fracture, can I charge for fracture care on the MRI followup visit?

Any input would be appreciated.

Thanks!
Tobi C.
 

Orthocoderpgu

True Blue
Local Chapter Officer
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Salt Lake City, UT
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What diagnosis are you linking to the fracture care?

If your physician "suspects" or does not see a fracture, I would not bill fracture care. What diagnosis could you link to it? Are you billing fracture care with a fracture diagnosis that is only "suspected"? If so that would be wrong.

Personally I would not bill for fracture care unless you know that there is a fracture. I understand that a fracture may be difficult to see at first since there is no re-growth line.

I would also look at this from an auditing point of view. If you are billing for treating a fracture when no fracture is identified, your doctors could be paying back a large sum of money with fines added to it.

The physician can initiate fracture care at any time, but since it has a 90 day global, the sooner the better. But there better be a fracture.
 

fltbaroque

Networker
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Longview, TX
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If your physician "suspects" or does not see a fracture, I would not bill fracture care. What diagnosis could you link to it? Are you billing fracture care with a fracture diagnosis that is only "suspected"? If so that would be wrong.

Personally I would not bill for fracture care unless you know that there is a fracture. I understand that a fracture may be difficult to see at first since there is no re-growth line.

I would also look at this from an auditing point of view. If you are billing for treating a fracture when no fracture is identified, your doctors could be paying back a large sum of money with fines added to it.

The physician can initiate fracture care at any time, but since it has a 90 day global, the sooner the better. But there better be a fracture.
That's the way I felt about it, too. Thanks for your input!
 

TPeniston61

Networker
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Carlsbad, CA
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fracture care without fracture

The way I understand it, fracture care is ongoing management of the fracture (to make sure it is healing properly) during the global period once a treatment has been performed. But still, there has to be a fracture, not a suspected or possible one, only to be proven wrong by the x-rays or MRI.
 
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