Wiki Non-operative treatment and ORIF on same day

[iowagirl77]

I have an odd situation- the patient was admitted to the hospital by one of my providers for a hip fracture. The patient opted for non-operative treatment and the provider planned for pain management and physical therapy. Later the same day, the patient underwent ORIF by another one of my providers for this fracture. There are no notes as to why this changed- I assume the patient changed his mind.

Can I bill the E/M with 57 modifier (can 57 be used as the decision for non-operative fracture care?) and 27238 for provider one, and bill 27244-58 for provider two? Or can I only bill 27244 since the E/M doesn't indicate decision for the actual surgery, just non-operative care?

Thanks!

 

[Orthocoderpgu]

My assessment

As a practical matter, I don't see the first doctor getting paid. He could bill out the E/M with a -57 since fracture care does have a 90 day global, but I can't see the 2nd doctor performing surgery without performing an E/M first.

I would see if there will be any E/M documentation from the 2nd doctor because I think there would be.

The first doctor would not bill fracture care knowing that the patient can't come in for that.