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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