Fracture Care ?

cpccoder2008

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I'm new to Ortho coding and i'm a little confused on the whole fracture care. I understand if you bill fracture care everything after is global. But what if a patient is seen for a healed fracture ? Can we still bill fracture care ? What about if the fracture healed on it's on ? Like the patient waited too long to make an appt. Or what if a patient had an ORIF at another hospital and then was reffered for follow up care with us ? Can we still bill fracture care ? Also are there any good website's i can find this information ?
 

Lisa Bledsoe

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Just to clarify on your initial statement...after fracture care is reported not everything is therefore inclusive. You can still code for cast changes and supplies. Also, if a patient has an ORIF elsewhere and your doctor provides all of the post op care, you would code the ORIF CPT with modifier -55 and calculate the post op care amount based on RVU's (one time only). As for healed fractures, I think I would code E/M's only. I'm sure there are others with comments on these issues...
 

cpccoder2008

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I'm sorry i should have given more information. I do the billing for physician's at a hospital, so i can't bill the supply and cast codes etc.. So from a physician's billling only point of view, would you still bill the same way ?
 

Lisa Bledsoe

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I'm sorry i should have given more information. I do the billing for physician's at a hospital, so i can't bill the supply and cast codes etc.. So from a physician's billling only point of view, would you still bill the same way ?
You should still be able to code for the application (ie 29075).
 

cpccoder2008

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We are a teaching hospital so our physician's don't apply the cast or splints. But they do see the patients. So if he bills for treatment of a fracture, would the E/M be included or would it be appropriate to attach -57 ? Even though he didn't actually perform a procedure but he still bills as global.
 

Lisa Bledsoe

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Sorry to say, I don't work with teaching physicians. Better to leave this question to those who work in that area. Sorry - I was just trying to help.
 

cpccoder2008

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Sorry to say, I don't work with teaching physicians. Better to leave this question to those who work in that area. Sorry - I was just trying to help.
It's okay,, i'm not fully sure on how we are suppose to bill ortho, i just took over the service and wasn't confortable with the way the previous coder was billing so i brought it to my physician. He told me that even though he doesn't perform an actual procedure he can still bill Fracture Treatment. Then he wanted to know if we could bill the E/M with the fracture treatment. I told him that if you attach -57 it gets paid and he asked if that was appropriate since he wasn't actually doing a procedure. I just want to make sure i am billing his service right.
 
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Go to your compliance office

If you are at a teaching hospital I'm assuming you are part of a medical college. Go to your compliance office with samples of your ortho doc's notes and they should be able to help you code accurately for the services being provided.

Fracture care IS a procedure (even if there is no incision involved).

F Tessa Bartels, CPC, CPC-E/M
 
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