fracture care

K8teg1987

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Silt, CO
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  1. If patient seen in ER on 06/12/19 and they are dx w/xrays w/a fracture and given a splint, do we code w/just the E/M visit when they come in office on 06/13/19 or also code with the fracture care code and if so what modifier.
  2. If with the fracture care code, what code would that be
 

iowagirl77

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Cedar Rapids, IA
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We need more information to be able to answer this.

Was the provider that saw the patient in the ER in the same group as the in-office provider? Did the first provider bill fracture care? If they are separate groups such as ER physician and Ortho physician, I think it is likely that the initial fracture care wasn't billed in the ER. In that case, the ortho provider can bill the fracture care if they intend to take over management of it.

The fracture care code is dependent on the type of fracture and care given, so specifics are needed.
 

JMichelle

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LELAND, NC
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The fracture codes are to be billed for the overall "90 day" treatment of the fracture. So if the ER just put the patient in a splint and referred them to an orthopedic - then yes you should bill the fracture code because your doctor is creating the treatment plan. In these cases, we bill the new patient office visit with modifier 57 and the fracture code plus anything else we may do.
 

K8teg1987

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Point of clarification please? Are coders obligated to use fracture care codes when they apply or is it an acceptable option for offices to choose E/M billing over closed fracture care w/o manipulation codes because the “sum of the relative value units (RVUs) for the multiple visits is typically higher”?
 
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