Fracture Manipulation and Surgery

[Jrobinson78]

we had a patient with a displaced distal phalanx fracture which was manipulated in the office and then scheduled for surgery for the next week. can we bill for the manipulation or just the ov/xr/splinting?

 

[Orthocoderpgu]

Personally I would not bill the reduced fracture

Technically can you bill for reducing the fracture? Yes. However I would advise against it.

The fracture reduction in the office has a 90 day global. You know that it will be surgically reduced in a couple of weeks when the swelling goes down. Due to that, I would not bill the facture reduction in the office.

Now, if you reduce a fracture, with no intent on surgical intervention, and the fracture dislocates at a future point in time, then that is a different story.

You may need to speak to your physician about optics. Does the provider really want to bill a procedure worth 90 days if they already know that they are going to operate in two weeks? Would you want to get a bill with 90 days of service, for only 14 days of service? Your patient does not. And while you technically can bill it, it really looks bad to the patient and they think the doc is trying to rip them off.

Can you? Yes.

But should you? Not if you know the patient will need surgery after the swelling goes down.

 

[sxcoder1]

I would disagree and would bill the manipulation. We always bill for the reduction, even if surgery is planned. That happens often and I believe we should bill based on the work the doctor did, not on whether a code has a 90 day global or not. I would then bill the ORIF with modifier 58, staged procedure.