Fracture care

jpicco1

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Need some help on a fracture charge:
Patient came into office to see one of our doctors due a foot pain for a few months. Pt. had a MRI done that was ordered by her PCP.
Documentation states MRI confirms was reviewed and pt. has stress fractures of the second and third metatarsals. Alignment is normal. Pt. is improving and will not be put in boot. Will continue with hard-soled shoes. Follow up for x-ray in 4 weeks.

My question is, my doctor wants to bill and E&M and fracture charge for this visit.

I do not believe this to be correct as his documentation does not support his fracture charge.

Any advice would be greatly appreciated. Thanks

Jennifer, CPC
 

Chelle-Lynn

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With the information provided, I would agree that the a fracture care code would not be appropriate. It seems that the E&M code is more appropriate as fracture care requires restorative services which is not indicated in this case.
 

humdingr

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Documentation for fracture care codes

What exactly needs to be documented to code and bill for fracture care without manipulation? I have searched and searched and I cannot seem to find it in black and white. I would appreciate and experts input.

Thanks, Cindy
 

Ccgerson

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What I've gathered from fracture care guidelines is that any diagnosed fracture that requires at least 3 follow up visits, and most likely requiring a a splint/ sling to immobilize the fracture meets criteria for fracture care. Examples of when not to charge fracture care are if the provider documents "follow up prn" for a nondisplaced fracture. If the provider specifies to return in a specific number of weeks, than you should be safe to bill fracture care. Another example of fractures that may not be appropriate to charge fracture care are nondisplaced 5th metacarpal fracture, stable nondisplaced pelvic fracture.
 

jpicco1

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Thank you for the response. The physicians want to bill a fracture code due to the fact that they diagnosed them with the fracture, I do not believe that is correct and not all circumstances warrant fracture codes. Hopefully they will agree.
 

Ccgerson

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I almost always charge fracture care, because follow up is usually warranted and clearly documented. However, I just had a case yesterday where the physician documented "No orthopedic follow up needed" - it was for a small nondisplaced pelvic fracture, diagnosed in the hospital. I did not charge fracture care for that, but just the E/M consult. The whole point of fracture care is for the entire global period, inlcuding the "post op" or follow up phase. Without that, you can't charge fracture care.
 
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