Wiki Unrelated to fracture care

[jharrell]

I really need help on this, if someone has every come across this. I work in an Urgent Care Clinic. We had a pt come in and after the Dr examined she had the following dx codes.

Closed fracture of one rib
Contusion of shoulder

We charged a fracture care code and a e/m. I put an -57 on the e/m and linked it to the Contusion of the shoulder, but Medicare has denied stating pre/post operative care payment is included in the allowance for the surgery/procedure. But it is unrelated to the fracture care. Any advice would be great. I thought about putting -25 but wasn't sure.

Jessica Harrell, CPC

 

[cleanclaims]

Assuming you have enough documentation to support billing both an E/M and fracture code, you would use the 25 on the E/M code which would be linked to the shoulder and the rib DX goes to the fracture code.

 

[FTessaBartels]

-57 on E/M is correct

The -57 modifier signifies that this was the decision for "surgery" - or fracture care in this case.

If I understand the scenario correctly the patient came in as a result of some injury, with complaints (probably) of pain or reduced range of motion or ?

Your physician evaluated the patient and determined there was a fractured rib and a shoulder contusion. The physician then provided fracture care for the rib.

You should code the E/M with a -57 mod and both the rib fracture and shoulder contusion dx codes. You should also code your fracture treatment with ONLY the rib fracture dx.

If you did this and it was denied, I would appeal.

F Tessa Bartels, CPC, CEMC