Wiki Fracture Care

[LLRodgers]

Can anyone help with this one?

Coded a fracture with a fracture care code it was submitted to Gateway Health Plan, they denied and their reason is:

"The procedure code is inconsistent with the modifier used or a required modifier is missing"

I did not use a modifier and I can not see where one is needed.

Any help is appreciated.

Thank you,
LLR

 

[Orthocoderpgu]

Most fractures require a modifier for laterality

You did not state what the fracture was. But most fracture care codes should be billed with -RT, LT, or F1, F2, or T1, T2.

If by chance this is in a global period, you may need to add a modifier for that.

I always use these in billing for fractures.

Maybe letting us know what code was billed would be helpful.

 

[LLRodgers]

This was the first time we saw her for the left distal radius fracture the codes were

S52.502A
25600

The ICD 10 code tells that it is the left distal radius. I do not think that a modifier goes on this.

LLR

 

[mitchellde]

This was the first time we saw her for the left distal radius fracture the codes were

S52.502A
25600

The ICD 10 code tells that it is the left distal radius. I do not think that a modifier goes on this.

LLR

even though the diagnosis indicates laterality, you still must use laterality modifiers on unilateral procedures

 

[MI_CODER]

I agree with mitchellde and Orthocoderpgu. If the documentation states the procedure was on the left radius then I would put modifier LT on 25600.

 

[daedolos]

Optum shows cpt 25600 could use the 50 modifier so that shows it needs laterality. Therefore, I concur with the previous posters to add LT modifier.

Peace
@_*