Fracture treatment in the ER 27786-54

ItsUp2U

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The ER doctor is billing for a 27786-54 the CPT description is - closed treatment of distal fibular fracture (lateral malleolus); without manipulation
mod-54 reads surgical care only.

The patient did not have a surgery or surgical procedure. Can he really bill for that? He saw the patient, ordered x-rays, and gave the results, and request that a splint be put on, and then the patient f/up with an Ortho MD. Or he is OK to bill for that- "treatment" means what?

Shouldn't he only be billing for an E/M code (for his visit only)? Please advise.
 

Lisa Bledsoe

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I think the fracture care code should be billed by the ortho provider who will be taking care of the fracture. The ER doc should only bill an ER visit and splinting.
 

mbort

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Ethically the ER doc should leave that procedure code for the ortho doc, however because he did render the treatment, he technically is entitled to the coding for such.
 
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If the ER Dr did a manipulation, I would not see such a problem with this. However, since this is not the case, I believe he should have billed the ER visit, X-rays and casting (if applicable) since he is not following the pt.
 

Frosty

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I agree that the ER doc should only bill fracture care if it was MANIPULATIVE (& then use 54 mod since he wouldn't be doing the f/u care.) If he's not manipulating the fracture, he has no business billing fracture care - in my opinion anyway!
 
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