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Fracture Care Coding in Urgent Care

  1. #1
    Default Fracture Care Coding in Urgent Care
    Medical Coding Books
    I work for an Urgent Care clinic that sees patients that have traumatic injuries. Many of these turn out to be fractures and I'm a bit confused on how fracture care coding works. The clinic would like me to code the treatment of a fracture on every patient diagnosed with a fracture. If they are told to return to their clinic, we code the treatment of a fracture with no modifier. If they are sent to an orthopedic specialist, we code the treatment of a fracture with the -54 modifier.

    The first scenario makes sense to me because they are following up with the same clinic and they will be providing the global care. The second scenario I can't seem to wrap my head around. If the documentation only states that the patient was splinted, given pain medication and told to follow up with a hand surgeon, did they really provide the restorative treatment for that fracture? What if the hand surgeon did a more extensive procedure, would they be stuck with only a small portion of the reimbursement because they would have to attach the -55 modifier? I'm having a hard time understanding how an orthopedic clinic would be satisfied with coding a -55 modifier. I'm doing a bunch of research online and nothing seems to be geared towards Urgent Care, only Emergency Department physicians. It makes sense to me for my clinic to bill the splinting and not the fracture care. That way, if the orthopedist needs to do further treatment, they would get the "credit" or reimbursement they deserve for the amount of work they did.

    I'm really sorry if I'm confusing in any way. I'm just trying to find a resource that I can turn to for much needed help. Thank you in advance for any assistance you can provide!

  2. #2
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    Columbia, MO
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    There are two ways to bill for fracture treatment, fracture global, or fracture alternative. If you are not performing definitive fracture management by simply applying a splint until a specialist can better treat the fracture then you bill a visit level with a splinting code, this is fracture alternative and it can be billed this way when it is a non displaced fracture or a fracture beyond your providers ability to manage. In this way there is no global and the specialist can then apply fracture care when they perform definitive fracture care.

    Debra A. Mitchell, MSPH, CPC-H

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