Wiki Need help finding cpt code - The doctor is billing out fracture

rjenn86

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The doctor is billing out fracture care for dx 812.40 distal humerus fracture. I am not able to find a cpt code for 812.40 for the fracture care. I am wondering if I could use 24530, that is what I found for 812.41 and 812.44. He wasnt specific except saying distal humerus fx. I'm just needing to know if I can use that cpt code or should the doctor be more specific. Thank you
 
You always assume a closed fracture unless otherwise stated. What I am wondering is how did you arrive at the 24530? you must have a procedure note before you can code a procedure code, just saying a closed reduction of a distal humerous fx is not sufficient information for a procedure note, the provider needs to be specific as to exact location of the fracture and exactly what treatment was delivered.
 
Thank you. It was a closed procedure done in the office. The only dx was distal humerus fx, and no cpt code pairs with that..so I pulled up 812.41 which is paired with cpt 24530.
 
I do not mean to judge, but it sounds as though you are getting your procedure codes from the diagnosis the physician gives the patient. You should only assign a procedure code that is appropriate and matches the procedure's documentation. The same goes for the diagnosis code. If you find after you get a procedure code and a diagnosis code from the documentation that they do not "match up" then you need to take the codes that do match up (per the payer policy) and ask your doctor if any of the codes listed by the payer are more appropriate. A lot of books on the market give you codes that "match up" to make your job as a coder easier, but, this is not how you should choose your codes. Your codes should only be based on the documentation.

On the other hand, maybe I am just misunderstanding how you are choosing your procedure codes......

Just trying to help....
 
Thank you. It was a closed procedure done in the office. The only dx was distal humerus fx, and no cpt code pairs with that..so I pulled up 812.41 which is paired with cpt 24530.

You will need a procedure note, as stated above I hope you do not select the procedure based on the dx code selected by the provider. The procedure note should have the specifics in it as to the procedure and the location. Always code from the documentation.
 
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