Wiki Needed in order to Bill For CPT 23500

[Kaidachi]

I'm not sure if this has already been asked.
I have been tasked with finding out exactly what a provider has to do in order to bill for CPT 23500 - Closed treatment of clavicular fracture; without manipulation.
We've had a couple of patients call back saying they were billed for 23500 but the provider didn't actually do anything during their visit.

Can anyone lead me to some resources to find this information out? or does anyone out there know?

Thanks for your help!!!

Kaidachi

 

[Orthocoderpgu]

Initiating fracture care

Your doctor needs to state that they are initiating fracture care. I know doctors think that this is "implied" and does not need to be stated, but I have had money taken back on fracture care and I was not able to support the code. So now I have the docs state that they are initiating fracture care and list the specific bone or fracture involved.

Don't let insurance companies (or patients) tell you that the doc is not doing anything. During the 90 day period the patient will need to be assessed multiple times to make sure that the fracture is healing correctly and has not become displaced, or mal or non union.


The best place to put this is in the assessment.

"Initiating fracture care for ..."

And then if the insurance says that it not documented, you can show them it is.

If fracture care is not being billed, remind the patient that they would get an office charge for every time they see the doc and look at the fracture to see if it is healing or not.

 

[hblakeman]

Fracture Care

In addition to what Orthocoderpgu stated, our office gives each fracture care patient a "Fracture Care Letter" at check out that clearly states why it's being billed and what it covers/doesn't cover.