Wiki question about E&M and fracture care

[tmgexp1@yahoo.com]

If the doc called the patient on Jan 23 and reported to her the CAT scan results which showed a fracture, and then had the patient come in on Feb 10 to the office, should I attach and E&M code along with the fracture care code? Does it matter that he already knew she had the fracture when she came in? Thanks for any help!

 

[mitchellde]

If he knew she had the fx prior to the visit then you can bill fx care only or visit level only.

 

[tmgexp1@yahoo.com]

Thanks for your help!

 

[jcbritton]

Hi Debra, Where can I find that "rule"? I've been trying to convey that to my providers, but of course need a source.
Thanks!
Jesscia

 

[mitchellde]

it comes down to the usage of the 25 modifier, in order to bill an office visit with the 25 modifier which is what it takes to get both to pay, you must an evaluation/assessment that is over, above, and beyond what is necessary for the procedure. When a patient has already been evaluated and the fracture type and site is known then there is no need for a significant evaluation as it has already been performed. any evaluation performed now is a part of the procedure itself, a provider would not perform fx care without also examining the fracture.