Wiki Ortho - 24560

KoBee

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Having trouble understanding if I am missing documentation or understanding the procedure definition correctly. I have a provider who is using CPT 24560 but I don't see a specific procedure note, shouldn't there be?? I feel is lacking documentation to support 24560. Please advice


History of Present Illness: This is a 9 y.o. female who present with Right Elbow pain after falling while riding roller skates.

No past medical history on file.
No past surgical history on file.
No current outpatient medications on file.
No family history on file.


No Known Allergies

Review of Systems

GENERAL: No unusual weight gain/loss or fevers.
EYES: No recent changes.
EARS/NOSE/MOUTH/THROAT: No complaints.
RESPIRATORY: No shortness of breath, cough, hemoptysis, or wheezing.
CARDIAC: No chest pain, palpitations, tachyarrhythmias or edema.
GI: No abdominal pain or change in bowel habits.
GU: No difficulty urinating.
MUSCULOSKELETAL: Denies all symptoms except for HPI.
NEUROLOGICAL: No seizures.
SKIN/CHEST WALL: No complaints.
PSYCHISTRIC: No recent significant change in mood or behavior.
ENDOCRINE: No significant change.
HEMATOLOGY/LYMPHATIC: No unusual bleeding or clotting.
ALLERGIC/IMMUNOLOGIC: No additional allergic reactions or recurrent infection

Physical Exam

Skin abrasion on elbow
ttp over olecranon
NTTP over lateral or medial elbow
Sensation intact to light touch 2/2 Radial, Ulnar, Median nerve distribution
Motor 5/5 Extensor pollicus Longus, Flexor pollucis longus, Dorsal interossei muscles, wrist extensors, wrist flexors

Imaging:
XRAY right Elbow: AP, Obliques, and lateral views: I do not appreciate a fracture

Assessment and Plan: This is a 9 y.o.female with right Elbow pain possible occult fracture
- LAC (long arm cast)
- Return to clinic in 4 weeks xrays oop. If fx will recast. If no fx, no cast
 
Of the different fracture treatment methods such as closed reduction and percutaneous fixation an orthopedic physician provides, closed treatment without manipulation involves fitting the patient to appropriate materials for bone stabilization and weight bearing/non-weight bearing function. This fracture treatment without manipulation is commonly provided by orthopedic surgeons at many different sites of service – inpatient, outpatient, office, or emergency department [ED]. Typically, orthopedic surgeons provide follow-up care until fracture healing has occurred and function has been restored.

Acceptable documentation for reporting non-surgical/non-manipulative fracture care includes buddy tape for muscular fracture in fingers, toes, immobilizer for knee (L1830), sling for elbow (24670), shoulder (23520, 23540, 23570), and swath (w/sling) for humeral shaft (24500), unacceptable, nonspecific documentation includes gait/balance training, home exercise program, physical therapy and non-weight bearing (NWB) with no elaboration.
 
While there does not have to be a procedure note for billing a fracture care code where no manipulation is performed, the provider cannot bill 24560 (in this example) because no fracture is documented. Provider only states 'possible occult fracture' and for the xrays 'I do not appreciate a fracture'. In other words this is not a confirmed fracture diagnosis and your ICD-10-CM code would be pain in right elbow not humeral epicondylar fracture.

Medical necessity for performing fracture care is not supported for a diagnosis of elbow pain. Not sure what the provider is hoping to find on follow up in 4 weeks to confirm or dismiss the presence of a fracture.
 
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