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Fracture Care

  1. #1
    Cool Fracture Care
    Medical Coding Books
    A patient is referred from his primary care physician for treatment of a fracture which is about 8 weeks old. He was seen by another physician initially given a cam boot, had one return visit, then discharged. As the patient was still having problems he presents to our office wearing the cam boot, referred to physical therapy and instructed to return in three weeks for follow up.

    Is is appropriate to bill a Fracture treatment Charge? I'm pondering this one.

    Thanks for your input!

  2. #2
    I found this on the AAOS website. Maybe it will help.

    Aftercare coding:

    Q: At what point in the patient’s progress should we stop using the fracture code and begin using the aftercare V58.x codes?

    A: Aftercare codes came out in 2002 and have been confusing. Here is supporting information from The Coding Clinic:

    “Three new subcategories and many new codes have been created to greatly expand the detail in the aftercare codes. Major changes were made to the orthopedic aftercare codes. Coding guidelines for the ICD-9-CM require that a fracture code be used only for an initial encounter for treatment. Subsequent encounters require the use of an orthopedic aftercare code. The problem was that the aftercare code provided very little detail. To remedy this, subcategories V54.1 (Aftercare for healing traumatic fracture) and V54.2 (Aftercare for healing pathologic fracture) were created. The codes under these subcategories identify the site of the fracture. It is not necessary to assign code V54.19 (Aftercare for healing traumatic fracture of other bone), or code V54.29 (Aftercare for healing pathologic fracture of other bone), more than once if several bones in the same subcategory are involved. A new code has also been created for aftercare following joint replacement, V54.81.

    “Broad new codes were created for aftercare following surgery for neoplasms, V58.42; for injury and trauma, V58.43; and for specific body systems, V58.71-V58.78. These codes should be used in conjunction with any other aftercare codes or other diagnosis codes to provide better detail on the specifics of an aftercare visit. The sequencing of multiple aftercare codes is discretionary.

    “Codes identifying aftercare following surgery of specified body systems (V58.71-V58.78), for neoplasm (V58.42), and for injury and trauma (V58.43) should also be used in conjunction with the V codes for post-operative wound dressing care, ostomy care, or other similar V codes, so that the wound dressing care or ostomy device is identified.

  3. #3
    at eight weeks post fracture, I would not charge for fracture care.
    Mary, CPC, CANPC, COSC

  4. #4
    Thanks, but I was more specifically referring to the procedure code. This is our first encounter.

  5. #5
    I wouldn't charge fracture care either.

  6. #6
    Quote Originally Posted by VIOLYNPLA2 View Post
    Thanks, but I was more specifically referring to the procedure code. This is our first encounter.

    Oops...sorry. I still wouldn't code current fracture care for a procedure code. An E/M should cover it.

  7. #7
    Columbia, MO
    Unless of course after 8 weeks the physician documentes a non -healing fx or mal union then you have an entirely different issue. The question is why after 8 weeks is there a question of fx care? Why did the patient come to you after 8 weeks and what was the evaluation? This could dramatically change the codes.

  8. #8
    That is a good point. That would make it a totally different scenerio.

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