Wiki Orthopedic Aftercare - When coding a follow-up

NFBarner

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When coding a follow-up visit for fracture repair in the orthopedic office, does anyone use the V codes, and if so, do insurance companies pay for them? For example, I use V58.43 for aftercare, I work at a large company, so have not been tracking the payment.
 
Global period

I'm not sure I understand your question. If it's in the global period (90 days) then there should be no charge and if there IS a charge, the insurance company will likely deny as "global."

We DO use 99024 to track these visits, but that CPT carries a $0.00 fee and is not reported to the insurance company. And we use V codes as our Dx.

F Tessa Bartels, CPC, CPC-E/M
 
Sorry for the misunderstanding. This is after the global period, say follow-up 3 months and 2 weeks for a total knee arthroplasty and I would use a follow-up E/M code.
 
I have used the following codes with good results. For follow up of fractures, if they are still healing I use V54.1x (healing traumatic fractures) or V54.2x (healing pathological fractures). If the fractures are healed then I would use V67.4 (Follow-up of a healed fracture). For total joints I have used V67.09 (Follow-up after other surgery) along with V43.6x (joint replaced by other means). Hope this helps.

Doreen
 
How about V54.81 "Aftercare following joint replacement" along with V43.6x for totals?
 
All but BCBS of FL in my case

I use the V-codes and am in FL.
BC does not use the V-codes. I do not understand why, because that is correct coding if they are coming in with no complaints to check on a healing fracture and the 90 day global. But BC of FL does not take them.
MCR definitely wants them. I use them for everyone else also.
:) Lynn
 
Help with Aftercare dx codes

I could use some help with understanding the use of aftercare codes. I believe I understand the use of the codes during the global period. After the global period, what do I look for in the documentation to let me know that I should use an aftercare code? Does the note need to say that the pt. is there for followup of fracture or surgery? How long after fracture care or surgery would aftercare apply?

I would also appreciate information regarding any references that would be helpful in ortho coding.

Thanks,
Ruth Hood, CPC
rh.hood@yahoo.com
 
Use of Aftercare Codes for admits to Rehab facilities

Hi Hope you can help clarify the correct use of aftercare codes!

1.) Can they be used for admits to rehab facility by the primary care physician for the reason for admission. Or are these codes primarily for the Surgeon?

2.) V66.4 Convalescence following treatment of fracture; can this be used for patients that are not recieving Palliative care?See Code corrects description.

V66.2 Convalescence and palliative care following chemotherapy
V66.3 Convalescence and palliative care following psychotherapy and other treatment for mental disorder
V66.4 Convalescence and palliative care following treatment of fracture
V66.5 Convalescence and palliative care following other treatment

3.) I know for the facility side they do want the V code for the follow up aftercare etc... My questions all pertain to the Professional Component for the Initial visits 99304-99306. Any help would be appreciated.
 
what if the order says follow up to fracture but the xray does not show healing fracture. Do you use the aftercare code for this or is this still considered an active treatment since the xray does not show healing. One coder at my facility says that anytime pts see ortho drs after the first initial treatment of the fracture such as in er and then they see the ortho dr all of these should always being coded as aftercare not acute . i was taught it has to say healing fracture before you can use the aftercare codes. please help with this and explain and there is some confusion in my facility about active acute fracture vs aftercare fracture when they are not in the healing phase. thanks
 
The most important thing to remeber is that the diagnosis is the patient's not the payers. The payer can tell us what they cover and what they consider medically indicated but not what diagnosis code to use for a particular encounter. We cannot change a patient's diagnosis just because a payer says they do not accept V codes. They DO accept them, they may have a policy regard medical necessity that a V code does not meet. So no matter what you cannot use the acute fracture code after the initial treatment, you cannot use the acute degenerative joint code after a joint replacement. Rehab is a V code and is first only allowed and is required for rehab encounters whether they are inpatient or outpatient. We need to use the code that fits the patient regardless of whether it is a V code or not.
I am not sure what you mean when you say the patient is not in the healing phase. If it is not documented as mal aligned or non healing then it must be healing. And there are other codes for mal aligned or non healing.
 
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