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level of risk - definitive care

  1. #11
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    Medical Coding Books
    I am agreeing with Tessa. Usually in the ER when they splint and referr on to ortho, the splinting is not strictly fx care it is to afford some comfort to the patient and to avoic further injury. So it is not considered fx care.

  2. #12
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    Hi All - jumping in here a little late, but I would consider the level of risk as moderate simply because there are 3 fractures and they are stabilizing until ortho provides definitive care. To me, the stablization is treatment.
    Lisa Bledsoe, CPC, CPMA

  3. #13
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    I need more details about the fracture itself in order to give my opinion. What kind of fracture? Closed, I know that. But were they broke in half? or shattered? or multiple fractures to the same bone? Does the ED think surgical intervention is required? thus resulting in the referral to ortho? I agree that "splinting" prevents further injury, doesn't necessarily treat the fracture itself unless the bone was placed back to its original position and then immobilized. Most times immobilization is the only treatment needed for a simple fracture. but was this a simple fracture? I'm guessing no. As soon as a bone is broken, the bone begins to grow back immediately, whether it's displaced or not. (I personally broke my pinky finger years ago, never had it treated, and I can't bend it all the way because it grew back together the way it was when it was broken) So, this leads me back to my original question, if the ED did not manipulate anything, why would they put a splint on? If for injury prevention, until the patient saw ortho, I would not consider this "moderate risk" This is why we need 2/3 to determine the overall medical decision making. More info please

  4. #14
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    I still say splinting (aka closed treatment) of the fracture(s) is moderate in the table of risk. It states "closed treatment of fracture or dislocation without manipulation".
    Lisa Bledsoe, CPC, CPMA

  5. #15
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    Quote Originally Posted by Lisa Curtis View Post
    I still say splinting (aka closed treatment) of the fracture(s) is moderate in the table of risk. It states "closed treatment of fracture or dislocation without manipulation".
    I agree. They did a treatment. It might not be fracture care, but it's still treatment without manipulation of a fracture. They did a splint and referred to ortho.
    So, as in most things coding---We have a split vote! LOL. It's one of those gray areas in our black and white world.

  6. #16
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    Oh so true Anna!!
    Lisa Bledsoe, CPC, CPMA

  7. #17
    Default Go back to the original question
    Treatment is under management options. We were asked what the Dx (ie presenting problem) would fall under on the table of risk. Several of us pointed out that there are other things to consider when leveling risk.

    Also, if they gave them an ice pack and told them to follow-up with ortho would you give credit for moderate risk? That is a treatment as well.

    To me, when they say treatment of fracture, they are giving you credit for taking on the care/outcome of that fracture. Which in this case they would not be.

    Just my opinions but I thought it should be pointed out that the question asked was not what caused the differing view points.

    Laura, CPC

  8. #18
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    Quote Originally Posted by katmryn78 View Post
    Treatment is under management options. We were asked what the Dx (ie presenting problem) would fall under on the table of risk. Several of us pointed out that there are other things to consider when leveling risk.

    Also, if they gave them an ice pack and told them to follow-up with ortho would you give credit for moderate risk? That is a treatment as well.

    To me, when they say treatment of fracture, they are giving you credit for taking on the care/outcome of that fracture. Which in this case they would not be.

    Just my opinions but I thought it should be pointed out that the question asked was not what caused the differing view points.

    Laura, CPC
    Great comeback Laura...

    After reading this thread, I agree with your comments.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  9. #19
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    Quote Originally Posted by katmryn78 View Post
    Treatment is under management options. We were asked what the Dx (ie presenting problem) would fall under on the table of risk. Several of us pointed out that there are other things to consider when leveling risk.

    Also, if they gave them an ice pack and told them to follow-up with ortho would you give credit for moderate risk? That is a treatment as well.

    To me, when they say treatment of fracture, they are giving you credit for taking on the care/outcome of that fracture. Which in this case they would not be.

    Just my opinions but I thought it should be pointed out that the question asked was not what caused the differing view points.

    Laura, CPC

    You are correct, they would not be taking on fracture care treatment...that would take us out of E/M all together.

    As far as just looking at the presenting problem section of the table of risk - do we then consider 3 closed fractures uncomplicated or complicated? Are they self-limited/minor? Does "3 closed fractures" indicate the same level of a presenting problem as the example of "simple sprain"? Do we have an uncertain prognosis? All good points in this thread. All good things to consider. Excellent discussion for our profession. I have the utmost respect for all opinions here, and respectfully stand by my opinion.
    Lisa Bledsoe, CPC, CPMA

  10. #20
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    Quote Originally Posted by Lisa Curtis View Post
    You are correct, they would not be taking on fracture care treatment...that would take us out of E/M all together.

    As far as just looking at the presenting problem section of the table of risk - do we then consider 3 closed fractures uncomplicated or complicated? Are they self-limited/minor? Does "3 closed fractures" indicate the same level of a presenting problem as the example of "simple sprain"? Do we have an uncertain prognosis? All good points in this thread. All good things to consider. Excellent discussion for our profession. I have the utmost respect for all opinions here, and respectfully stand by my opinion.
    Lisa,

    Your right, this is a wonderful discussion and with us all adding our two cents makes you stop to think what another is thinking. I always like these types of discussion because I feel that we always take something from it.

    Have a great day!
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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