Question stress fracture question

lisak0727

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I have a patient with a right femur stress fracture. At the time of her visit, the injury was already a month old. The stress fracture was confirmed via MRI. The patient presented already using crutches. The doctor advised continued use of the crutches, rest, and to remain out of work. Follow up in 4-6 weeks. Is it appropriate to bill fracture care for this visit?
 

StuC2018

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I disagree. This depends on whether or not the new provider provides invaluable treatment that was different from the original provider's plan. If the new provider was seeing the patient with the fracture for the first time and treating that condition for the long haul, they have every right to bill. Just think of what specialists do every day. They so often treat conditions that an urgent care, ER, PCP, or other provider has seen already. You may be denied but if you have a strong argument stating the treatment plan, other testing, etc. being invaluable to the patient's medical well-being, you have every right to bill/appeal. ERs and the like will merely splint just about anything and say that the xrays showed no fracture. The actual treatment and possibly smarter xrays, (view, etc.,) will come from someone with the time and expertise to treat! We routinely bill for fracture care in our office post ER and we do have to fight for these, but, it is possible to get paid for the fracture care. Even from Medicare!
 

lisak0727

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I disagree. This depends on whether or not the new provider provides invaluable treatment that was different from the original provider's plan. If the new provider was seeing the patient with the fracture for the first time and treating that condition for the long haul, they have every right to bill. Just think of what specialists do every day. They so often treat conditions that an urgent care, ER, PCP, or other provider has seen already. You may be denied but if you have a strong argument stating the treatment plan, other testing, etc. being invaluable to the patient's medical well-being, you have every right to bill/appeal. ERs and the like will merely splint just about anything and say that the xrays showed no fracture. The actual treatment and possibly smarter xrays, (view, etc.,) will come from someone with the time and expertise to treat! We routinely bill for fracture care in our office post ER and we do have to fight for these, but, it is possible to get paid for the fracture care. Even from Medicare!
What concerned us was the fracture was already a month old, he provided no additional treatment. She came in with her own crutches and told her to rest and continue doing what she has been doing.
 
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