MCD denied cpt code 27193

Kalispell, MT
Best answers
27193 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation - we billed Fracture care in the office. Medicaid denied stating this is an inpatient procedure and cannot be billed in office?? Can not find anything to support this.
You won't find any information that this needs to be performed inpatient because Medicaid is wrong. The key here is that there is no manipulation. That means that the fracture should "heal in place". The physician does not have to manually put the bones back in place. But fracture care is very important right now. The patient will need to come back and be x-rayed multiple times to make sure that the bones are healing and have not displaced since the patient was last seen. Should the fracture displace, it will change the treatment plan completely. Since this can be treated "non-operatively" at least for now, this does not require an admission. Make sure all of this gets pointed out clearly in your appeal. It's not infrequent that fractures displace during the fracture care period and ORIF is then required, or the bones don't heal well. Good luck.
I don't know where they are getting it either. Usually Medicaid follow Medicare I believe. The CMS inpatient only list would be APC status C and this px is a Status T so should be allowed outpatient.