Wiki FRACTURE CARE

[MelissaTurley]

I code for an Orthopedic practice. We have providers that consult in the hospital and will splint/cast/immobilize a fx, set pt to follow up in office, and then when the pt comes in to the office to follow up they will see a different provider and that provider wants to code for fx care. My question is, is that appropriate, or is there a modifier we could use. I had looked at Modifier 54/55 but am not sure if it would work for this situation? TIA.

 

[Orthocoderpgu]

Does the physician who sees the patient in the hospital want to bill fracture care too or just the E/M and splinting?

 

[MelissaTurley]

We bill for the fracture care based on the original consult note. Once they come to the office, if another provider does the follow up care they are wanting that provider wants the fracture care. It is my understanding the provider who made the decision for initial treatment would get the fracture care code. Would this be correct?

 

[Orthocoderpgu]

No, that is not correct. And fracture care codes can't be billed out on assumptions. If a physician wants to bill fracture care, they have to document it. It cannot be implied. If the doctor who sees the patient in the hospital wants to bill fracture care they can, but it must be documented. And since fracture care has a 90 day global it would not be appropriate to bill it unless the physician is actually going to monitor the patient for 90 days too. If they are not you can add the -54 modifier to it. And then the other physician at the clinic would have to bill fracture care with -55. I would have the doctor who treats the patient in the hospital stay with that doctor for the follow up treatment especially since the patient will be going to the same clinic for the aftercare.

 

[MelissaTurley]

Thanks so much for your help.