Wiki Fracture seen in hospital

[LLRodgers]

Can anyone direct me on how I should of coded this:

1. The patient slipped and fell on ice on 1/31/15 and went to the ER
2. She was in a lot of pain and she lives alone and did not want to be home alone while in so much pain ER admitted her and they did a CT scan to see if she did in fact have a fracture pelvis
3. Then on 2/2/15 they discharged her to our Acute Rehabilitation Facility for Pt and OT Ambulation
4. Our doctor saw her there on 2/4/15 and our other doctor saw her there on 2/1215
5. Discharged from Rehab on 2/2/15 by a doctor not in our practice and ordered hospital bed for home and use of walker
6. We then saw her in our office on 3/11/15 for the first time.

I had coded this as a healing fracture code with an E/M code and then in talking with one of our billers it was pointed out that I should have coded a fracture care since the hospital does not code fracture care. So we changed it to a Fracture Diagnosis and a Fracture Care code.

Now we have a supervisor telling us that the fracture care started on 2/4/15 (that is when we saw her in the Acute Rehabilitation Facility at the hospital) and it was coded 808.8 (fracture) with a 99231 (subsequent hospital care) then on 2/12/15 it was coded the same way (subsequent hospital care)

Then on 3/11/15 (when the patient came into our office for this) I coded V54.13 with 99212 then I was told since the hospital does not code fracture care I should have done that so it was changed.

Now I am being told the Fracture care started on 2/4/15 not 3/11/15 So I am confused how I should of coded this when they came to our office for the first time.

Should I have coded a V54.13 with a 99024?

Thank you!
Linda

 

[mitchellde]

It was an acute fracture when it was diagnosed per the radiology. If no dx of fracture was ever rendered then it could not be coded. It is only an acute fracture until treatment is rendered. The hospitalization with immobilization would be the treatment for a pelvic fx. The acute fx code should not be used for any of the follow up encounters regardless of when you see the payient. The patient now has a healing fx and it should be coded that way with the V code. The admit to the rehab, if it is for rehab services is coded with the V57 code first list and the V code for healing fx second.
So the acute fx code would have been used in the ER and the acute in patient hospital. Once the payient was discharged to rehab the fx dx code is a V code in ICD-9. You are not to use the fx code for subsequent visits. Fx care is not always coded as fx care. It is sometimes codec as just office encounters. You cannot come into a fx case during the rehab part and start coding fx care.
Fx care started on 1/31.