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E/M w/known fracture

  1. Default E/M w/known fracture
    Medical Coding Books
    Hello Everyone,

    We are having a discussion and I was to see what you guys think:

    If a patient comes in with a known fracture (referred by their PCP, urgent care clinic or ER), would a new patient visit (or established) be billed with modifier 57 with the fracture cpt code? Even though the patient comes in with a known fracture, our doctors are still having to do the medical decision making on how to handle the fracture. And most of the time, the doctor has never seen the patient, so he is doing the necessary history and exam.
    Codegirl0422, CPC

  2. Default Cpc
    If the patient has never been into your office, it would be coded a new patient without question.

  3. Default
    Thanks, would you have anything in writing or direct me to the information. That is what I thought but several of us here disagree on this.

    Thanks for your help.
    Codegirl0422, CPC

  4. #4
    Default
    http://www.aaos.org/news/aaosnow/jul08/managing2.asp
    “Global” reporting of the services by using the 90-day, global fracture code with or without reporting the initial evaluation and management (E&M) service that resulted in the decision for closed treatment,

    Our office uses the "global" fracture care, therefore, we bill the visit new/ est with -57 only if this is the first time we are treating this fracture.

  5. Default
    Thanks

    Quote Originally Posted by cpccoder2008 View Post
    http://www.aaos.org/news/aaosnow/jul08/managing2.asp
    “Global” reporting of the services by using the 90-day, global fracture code with or without reporting the initial evaluation and management (E&M) service that resulted in the decision for closed treatment,

    Our office uses the "global" fracture care, therefore, we bill the visit new/ est with -57 only if this is the first time we are treating this fracture.
    Codegirl0422, CPC

  6. #6
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    It was my understanding the the -57 modifier is decision for surgery, shouldn't the modifier be -25 for closed treatment. Also, a new patient is
    one that has not been seen in your practice for 3 years.
    jdemar, CPC, CMA

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Closed treatment is "major surgery"
    Since fracture care carries a 90-day global period it is considered "major surgery" even though there is no incision (i.e. closed treatment).

    The -57 modifier is the appropriate one to use.

    F Tessa Bartels, CPC, CEMC

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