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Fracture Care

  1. Question Fracture Care
    Medical Coding Books
    I'm new to ortho coding & feel like I have no resources in my office . Where can I find documentation regarding fracture care i.e. surg code only, only one Dr in the practice can bill for it because same TIN?

    I'm being told that I have to go talk to a Dr & tell him that he can't bill a consult & fx care on the same dos & then subsequent dos he must do post op's not EP. I agree that if he wants to do fx care, that is all we can bill because that is the highest RVU + casting materal and any x-rays and then the patient would be in global for 90 days. I believe he could do fx care and a consult if he consulted on another body part. But our billing office has no direction so it seems that I'm on my own so any help you can give me I would appreciate

  2. Wink
    You can only bill postoperatively for that fracture care. Should the patient be seen for something else during that postoperative visit, then you may bill a separate E/M with modifier 24 for the problem being seen for, i.e., patient has a fractured right ankle, comes in with a new complaint of left knee pain during that postoperative visit, doc may bill a separate E/M-24 for that knee pain.

    I don't know if this helps or not.

  3. Default
    Thanks and I understand the mod -24 rule it's just on the same date of service could we bill an e/m with a mod -25 with the fx code? Dr says yes, my boss says no. I'm on the fence...I'm actually leaning more towards an e/m with a mod -57 for the e/m for commercial payors even though it won't be an open procedure it's still the "surgical package." The more I read the def of mod -25 the more mixed up I get...the CPT book says you can use the same dx for the e/m as the procedure on the dos but MCR guidelines say no.

    Has anybody else had any experience with how they are billing these out?

  4. #4
    Location
    High Point, NC
    Posts
    84
    Default
    You can bill for an E/M on the same DOS as the Fracture care as long as the provider completes & documents a full exam - you would append modifier -57 since the fx care is a surgical code with a 90 day global. The basic rule of thumb is to use modifier -25 for procedure with a 0-10 day global and to use the -57 modifier for procedures with a 90 day global. Hope this helps.

  5. Question Casting Supplies
    If A Patient Is Seen For A Fracture And Our Dr Reads The Xray,then Applies The Cast. How Should We Bill For This? And If The Patient Gets The Cast Wet, Or Object In It Can We Bill For Casting Supplies Of A New One? And Which Code Would Be Used? Sorry For So Many Questions

  6. #6
    Default
    Quote Originally Posted by mfrierdich View Post
    If A Patient Is Seen For A Fracture And Our Dr Reads The Xray,then Applies The Cast. How Should We Bill For This? And If The Patient Gets The Cast Wet, Or Object In It Can We Bill For Casting Supplies Of A New One? And Which Code Would Be Used? Sorry For So Many Questions
    If your doc initiated the fracture care then bill the fracture care code. The first cast application is included with the fracture care code, supplies are always billed seperately. All subsequent casting can be billed seperately using the appropriate cast code no matter what the reason for re-casting. Hope this helps.

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