Wiki fx care help

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ahodge90

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My physician is asking if there is any documentation that has been put out that says whether we can bill an e/m with fracture care. I am not really finding anything that shows anything definite. Does anyone know of any resources I can go to for this information?
 
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These are references below, keep in mind they are older dates and may not take into account the new 2021 E&M guidelines. It's a constantly questioned and debated subject. It also causes anxious patients and makes it tough for the billing folks when it is not explained well at the time of service because the non-op fracture care codes live in the "surgery" section of the CPT book. There is also misinformation that can happen at the time of service from the front desk area and sometimes others because of the global it may or may not put the patient in. I am speaking about in-office, ED would be a different story (from experience).


From a coding standpoint the documentation would have to support a separate E&M on the same date of service as the procedure.
Many practices have a policy on non-manipulative fracture care. There are basically two options: the "global" route or the E&M "itemized" route. You can't switch back and forth.
I have personally spent many hours on the phone with patients explaining this when they get a big hit to their deductible (due to a "surgery") or don't understand that all of the follow up care is in a global for that fracture.
Here's an example - patient goes to urgent care on Sunday, X-Ray foot, told they have a fracture, put in a boot and crutches. F/U with ortho Monday, we already know they had a fracture, they are already in a boot/crutches, they brought outside XR. Do we really charge an E&M on top of a non-op fracture care CPT to tell them yup - stay in the boot and no additional visit work done? I think it all comes down to provider preference and the quality of the documentation and what work was done in the individual visit. Was there E&M work done over and above the pre, intra, post service work already figured into the fracture care CPT RVU?
 
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Thank you for your response!

I agree that there is a ton of information out there and honestly nothing is totally straight forward. I don't feel his documention supports an separate e/m outside of the fx care codes therefore I kind of understand why the insurances would deny the e/m for bundling. My provider just doesnt understand why he cant do this with every fx care case he see's. I will go thru what you have given me and see if this will help me explain things for him. I just wanted to know if I was in the wrong for thinking he probably should not be billing for fx care and an e/m because He is sure that I am.
 
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