Wiki Need help with global fracture care

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flogale2

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Hi is anyone familiar with the guidelines for global fracture care services.

Particularly when the physician does the initial consult. How is that coded? Do I need to add a modifier to the e/m code? I know initial cast is included and then any additional casts need to billed.

Also I have read that you need to put a 58 modifier on any additional cast applications.

I am so confused!!!!
 
You would need a modifier on the E/M, as long as the documentation supports. Modifier 25 or 57 depending on payor guidelines. Some payors also require the 58 modifier and subsequent casting codes.
 
EXAMPLE:
Patient comes in with left wrist pain. X-rays show a non-displaced distal radius fracture and the physician applies a cast. You code the fracture care as 25600 LT. You may also code the supplies. In our office, we would use fiberglass casting so we would code Q4010 (for patient 11+) for the supply. The application of the cast is included in the fracture code. The fracture code carries a 90 day global so E&M visits for the follow up up the fracture are included for the following 90 days. If the patient is seen for another problem in that time-frame, than you would append modifier 24 to the E&M. If the patient comes in and requires a cast change, then you would append modifier 58 to the application of the cast code.
 
active fx dx vs aftercare dx

on this note as well, how long is it appropriate to continue using the original fx dx ie: 812.02, 812.03, versus using aftercare for healing traumatic fx sx codes ie: V54.11?? My understanding is to only use the original fx dx on the 1st claim, after that, it should be V54.XX for the aftercare of the fx...any thoughts?
 
The fracture is coded as acute until treated. So once the manipulation /reduction is performed then the next encounter is coded as aftercare. Coding clinic 2001 I belive it was 1st quarter also reinforced this.
 
They are an AHA publication and are not free. You will need to go to the AHA coding clinic site. Most hospital medical record departments subscribe to them so you might could go there and read them
 
KMCFADYEN said:
EXAMPLE:
Patient comes in with left wrist pain. X-rays show a non-displaced distal radius fracture and the physician applies a cast. You code the fracture care as 25600 LT. You may also code the supplies. In our office, we would use fiberglass casting so we would code Q4010 (for patient 11+) for the supply. The application of the cast is included in the fracture code. The fracture code carries a 90 day global so E&M visits for the follow up up the fracture are included for the following 90 days. If the patient is seen for another problem in that time-frame, than you would append modifier 24 to the E&M. If the patient comes in and requires a cast change, then you would append modifier 58 to the application of the cast code.
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Would you charge an Office visit for this date of service?
 
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