Wiki Manipulation of previous fracture and re-casting in the office


True Blue
Mims, Florida
Best answers
My Ortho billed the global codes for fracture care without manipulation for a patient who had a tib-fib fracture. The patient presented to the office for a follow-up visit with a complaint that the cast was too tight and bothering her. He removed the cast and x-rays show that the fracture site had a slight movement, so he manipulated the fracture and re-cast it (PTB cast).

How would I bill for this? Can I bill for the manipulation or would I just bill for the new cast?

Thanks for all responses!
You can bill the fracture with manipulation and the 58 modifier since this procedure is more extensive than the original. if you do bill this then the new cast is included in the fracture care code.
Historically, Medicare and other payers do not even pay for "Closed Treatment of (any) Fracture Without Manipulation" (unless something has changed recently). Since there is a Global Time Frame for such Treatment Codes, there is not likely to be any payment for care during that time frame, except for follow up X-rays (technical and professional components), and cast/splint supplies and application (if there is a cast/splint change during the course of treatment). He is more likely to get paid something if he just charges for the Initial New Patient Office/ER/OPD Visit E&M Code (wherever) and the Cast/Splint Application Charges (plus materials if seen in his office) with Modifier 25 initially, and then do all Subsequent Office Visits, X-rays, Cast/Splint Materials and Application, etc. on and individual per visit basis. That gets around the Global Time Frame business (no payment), and it is a legal alternative.

Respectfully submitted, Alan Pechacek, M.D.