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Billing Fracture Care Codes

  1. #1
    Location
    Knoxville, TN
    Posts
    39
    Default Billing Fracture Care Codes
    Medical Coding Books
    Wow- okay so it seems from reading all the posts that billing for fracture care codes bring up alot of questions. Here is is my question:

    My physician is consulted to the hospital for a patient who has a closed ankle fracture. The physician dictates that that he treated this fracture conservatively. He does not state whether he plans to follow the patient in the hospital or have the patient follow up in the office once she is discharged. This is a nursing home patient so my guess is that he would not be following up with her, but I'm thinking they really need to put that in the dictation.

    If the physician is not planning on following up with the patient then we should not bill a closed fracture care code since 21% of the payment is for post-op care. Without knowing if any other physician is planning on taking over post op care then I don't think we could bill the fracture code with a modifer 56/54 either.

    I'd just like to hear what everyone elses thoughts are. Thanks.
    Christy Brown, CPC
    Humana, Clinical Guidance Coder
    Knoxville, TN

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I believe I just asked you some questions on the DH ortho forum on this, but for all due purposes, I will ask them here to:

    Did he splint the patient?
    or cast the patient?
    Did he send treatment orders to the nursing home as to how to treat/care for this fracture?

    Even though the patient is in a NH, doesnt mean the patient wont be transported back to your office for follow up. We see NH patients for fracture follow up on a regular basis.


    Mary,CPC, COSC

  3. #3
    Location
    Knoxville, TN
    Posts
    39
    Default Billing Fracture Care codes
    Yes Mary, you did and thanks for responding. I answered it on the DH forum as well, but I'll answer it here to. As I look at the dictation again

    He states that she will be treated with splinting, fracture boot and observation. He says nothing about writting orders to the nursing home. The fact that he doesn't say what his intentions are regarding following up with the patient bothers me. Am I just questioning this too much?

    Thanks for your help.
    Christy Brown, CPC
    Humana, Clinical Guidance Coder
    Knoxville, TN

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by chrislyn1977 View Post
    Yes Mary, you did and thanks for responding. I answered it on the DH forum as well, but I'll answer it here to. As I look at the dictation again

    He states that she will be treated with splinting, fracture boot and observation. He says nothing about writting orders to the nursing home. The fact that he doesn't say what his intentions are regarding following up with the patient bothers me. Am I just questioning this too much?

    Thanks for your help.

    I would check with your doc regarding the nursing home orders for treatment and follow up. This is not something that you would normally get and may have to request from the hospital.

    Mary, CPC, COSC

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