Re-fractures

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New Hartford, CT
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Patient fractured 5th right metacarpal 3/14/08, has 90 day global. On 5/7/08 patient re-fractured same metacarpal. How would this fracture charge be billed as it is in the global period from first fx? The OV notes say that the pt re-broke the old fracture and patient was placed in a short arm cast. Would this new fracture be inclusive, as global, to the original fx or can we bill a fx charge with a 76 modifier?
 
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This is a good question, and I am curious to see what others think about this. I would generally say this would be a complication of the original fx and if it is well documented the original fx healed, then I don't see why you can not bill the fx care... but I would use a 78 modifier.
- Anyone else??
 

mbort

True Blue
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ENGLEWOOD/DENVER
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Does the documentation state how the patient rebroke the fracture? If not, I would certainly ask the doctor to scribble something for documentation purposes.

This is codeable/billable and not considered part of the global package nor a complication of the original fracture because (hopefully) we have documentation to support the "re-break". A complication of such would be more along the lines of a non-union/mal-union type situation.

Hope this helps
Mary
 
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