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pediatric orthopedic coding??

  1. Unhappy pediatric orthopedic coding??
    Medical Coding Books
    My specialty is definitely not orthopedics! I took my daughter to her PCP because she fell on her RT elbow. She rec'd an xray and was placed in a splint. The PCP stated she thought there was a fracture in the growth plate of the RT elbow. Doc sent the xray out to be read for another opinion. She was sent to a children's ortho for further evaluation. After reviewing xrays (new and old) the ortho stated that it was very probable there was a fracture. He recommended casting or splinting. After discussion with the doc, we both decided it would be best for her to receive the cast as she is very active on our farm. She was casted from the bicep to the knuckles. After receiving a rather large bill, I investigated a bit. I was charged a 99213, 73030, 29065, and A4590. The part that "flipped me out" is that the ICD-9 codes billed were 923.00 and 923.11 which are contustion of the elbow and contusion of the shoulder. I read the guidelines for the casting code of 29065 and I am confused. Can anyone tell me if these codes are appropriate for her situation? Also, anyone with ortho experience, is it common to charge so highly and cast for a contusion???? Thanks in advance for any input.

  2. #2
    Milwaukee WI
    Default Can't code fracture
    The orthopedist couldn't code for a fracture because there wasn't one clearly identified ... it was only "probable." So s/he is left with the contusions that CAn be coded.

    You indicate that you "both" decided it was best to place her in a cast. So it was appropriate to receive a charge for applying the cast. The orthopedist appropriately did not charge for fracture care (which would have required the definite fracture diagnosis).

    What surprised me is that you had a 99213. I would expect from your description of events that you might have been charged for a consult, or at least a new patient code (unless, of course, your child has seen this orthopedist in the last 3 years).

    It's not uncommon in pediatric orthopedics for the initial xray to not show the fracture. Later xrays may show evidence of the healed fracture which will give them a more definitive diagnosis.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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