schapolunate ligament sprain w/distal radius fx

beck627

Networker
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37
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Hello all~ I need help with a discrepency in our coding dept. We have a patient who was treated for a distal radius fracture and put into fracture care treatment w/90 day global. We applied a cast. At the time of the treatment they sent her for a CT scan to determine the injury to the scaphoid-lunate area. She returns to the office to go over CT scan results and then sees another doctor in our practice (same tax id, both orthopedic surgeons) and he is more focused on the scapholunate ligament sprain that occurred at the time of the fracture. He is going to have her go thru the closed treatment and after that time is going to re-evaluate to see if she is going to need surgey to repair it. The question is are we justified in billing out an established patient visit w/modifier 24 for the scapholunate sprain visit? We both have very strong feelings regarding this and can't come to an agreement. Thanks for any help!
 

coder911

Guest
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54
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Portland
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The fact that the other doc is going to require a seperate follow-up for the sprain gives me reason to believe this is a different issue. Just make sure you have enough elements to support whatever OV level you're going to bill for the sprain.
 

kandigrl79

Guru
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118
Location
Philadelphia
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I would say modifier 24 is definitely justified. Clearly there are two separate sites and two separate issues. Just make sure that everything documented properly and you should be fine.

kandigrl79:)
 
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