Results 1 to 8 of 8

explanation to patient for fracture care help

  1. #1
    Default explanation to patient for fracture care help
    Medical Coding Books
    ??can anyone give me assistance on explaining "fracture care" to a patient that is told by her insurance co, she was charged for "surgery" and the patient is adamant she did not receive surgery--what she received was fracture care to the 4th toe while in office. I cannot get her past the word "surgery"--she feels that because she was not "in" suregery, she did not receive "surgery". I have explained all the care she received, but I cannot get her to listen. She continually states "I did NOT go to surgery".
    Thanks! Shelli

  2. #2
    Duluth, Minnesota
    so, what procedure code was used for the fracture treatment?
    Donna, CPC, CPC-H

  3. #3
    28510 T8

  4. #4
    North Carolina
    I would try to explain that insurance companies require that we bill our services using a coding system known as CPT and that these codes are used to describe the service that are located in the "surgery" section of the CPT codebook. It does not imply that the patient had an operation, per se. This is merely the way the CPT book is organized for ease of use by both the insurance companies and physicians.

    Maybe it will work...or not.
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

  5. #5
    Duluth, Minnesota
    well, if you have a Coders Desk Reference book you could show it to her - or read the description to her:
    28510 - The physician treats a fracture of one of the four toes other than the big toe. No open surgery or manipulation of the toe or foot is required. X-rays (reported separtely) of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physican applies a splint, brace, or cast to the toe and foot.

    that's pretty clear ... even states "no open surgery"...
    Donna, CPC, CPC-H

  6. #6
    thanks! crossing my fingers (and toes) she will actually listen to explanation. Thanks again!

  7. #7
    East Stroudsburg, PA
    I have had this a lot from patients. I explain that although they didn't have surgery, they had fracture care performed by an orthopedic surgeon. In addition, the code is under the surgery section it is specifically stated in the description that it is a closed treatment not surgery. At the front of the section in the CPT book it states that closed treatment is a fracture site that is "not surgically opened"

  8. Default
    Also include in your explanation that this procedure has a 90-day global period. She will not be responsible for any charges related to the fracture care (unless, God forbid, she needs to go to the OR for a fracture related procedure or she needs a cast change). That may also help your case.


Similar Threads

  1. Replies: 5
    Last Post: 03-20-2017, 04:22 PM
  2. Fracture Care, Mods 54/55, Medicare Patient
    By Patrick07 in forum Modifiers
    Replies: 2
    Last Post: 06-25-2014, 08:51 PM
  3. Closed Fracture Care and Open Fracture Care
    By kathy a in forum Orthopaedics
    Replies: 6
    Last Post: 07-09-2012, 10:07 AM
  4. Patient referred during fracture care period
    By AR2728 in forum Orthopaedics
    Replies: 1
    Last Post: 03-30-2012, 08:00 AM
  5. OV with Fracture Care & What Constitutes Fracture Care
    By rryder1963 in forum Orthopaedics
    Replies: 1
    Last Post: 03-26-2012, 08:19 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.