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Fracture Care - splint applied

  1. Default Fracture Care - splint applied
    Medical Coding Books
    A patient was seen as a consult in the ER on 10/11 by an Ortho doctor. A closed reduction with hematoma block was performed and splint applied. Patient was admitted to observation on 10/11. On the next day, 10/12, it was decided that the fracture was unstable and the patient needed ORIF. Can the E&M with a -57 and the closed fracture care be billed on 10/11 or is it all covered in the charge for the ORIF performed on 10/12 or would only the E&M on 10/11 be billable?

  2. Default
    Quote Originally Posted by rcaclaims View Post
    A patient was seen as a consult in the ER on 10/11 by an Ortho doctor. A closed reduction with hematoma block was performed and splint applied. Patient was admitted to observation on 10/11. On the next day, 10/12, it was decided that the fracture was unstable and the patient needed ORIF. Can the E&M with a -57 and the closed fracture care be billed on 10/11 or is it all covered in the charge for the ORIF performed on 10/12 or would only the E&M on 10/11 be billable?
    No you can't bill for fx care on the 11th if pt is going to OR for ORIF on the 12th.
    You can bill for the E/M for the 11th with 57 mod and the ORIF on the 12th. That's it.

  3. Default
    you can code for the splinting in the ER, not the fracture care. Hope this helps.

  4. #4
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    Default
    Quote Originally Posted by rcaclaims View Post
    A patient was seen as a consult in the ER on 10/11 by an Ortho doctor. A closed reduction with hematoma block was performed and splint applied. Patient was admitted to observation on 10/11. On the next day, 10/12, it was decided that the fracture was unstable and the patient needed ORIF. Can the E&M with a -57 and the closed fracture care be billed on 10/11 or is it all covered in the charge for the ORIF performed on 10/12 or would only the E&M on 10/11 be billable?
    Yes, you can code for the closed reduction on 10/11 and the ORIF on 10/12 but you will use modifier -58 on the ORIF.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default
    I agree that the closed reduction can be billed on the 11th and the ORIF on the 12th with modifier

  6. Default
    The original question that was posted said the ORTHO DR in the ER did closed reduction then took pt next day for ORIF so if it was the same dr then I would only bill for the Consult with a 57 mod for date of service 10/11 and the ORIF for date of service 10/12.

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by rcaclaims View Post
    A patient was seen as a consult in the ER on 10/11 by an Ortho doctor. A closed reduction with hematoma block was performed and splint applied. Patient was admitted to observation on 10/11. On the next day, 10/12, it was decided that the fracture was unstable and the patient needed ORIF. Can the E&M with a -57 and the closed fracture care be billed on 10/11 or is it all covered in the charge for the ORIF performed on 10/12 or would only the E&M on 10/11 be billable?
    For the physician I would code 10/11 consult -57 and closed reduction. For 10/12 hospital f/u -57 and ORIF -58.
    Lisa Bledsoe, CPC, CPMA

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