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Thread: 72 hour rule

  1. #1

    Default 72 hour rule

    AAPC: Back to School
    Can anybody tell me that, can we follow 72 hour rule for coding fracture care in ED , please provide me a documentation where it is available.

  2. #2

    Default Depends....

    Most ED Coding organizations do not do this. This is usually viewed as a compliance issue. So if the doc only documents 3 HPI and you return the chart looking for a fourth, what is the reason besides being able to code a higher level? I have seen one organization do this. They are very careful to make it clear that they are looking only to have charts complete based on the clinical presentation, not to code higher. Another issue is timing. If there is a way you can return these charts close to real time, it passes the compliance sniff test a bit more. Usually this is unrealistic unless you are coding on site. I've reccomended at times that someone is trained on site to audit charts. This might be worth doing.
    Hope this helps.


  3. #3

    Default Wrong Reply!

    As you can tell I was answering another question! Sorry about that. I do believe the 72 hour rule is based on old payor rules referring to timing of referrals to an orthopod from the ED. I think that term is now used to generally document an ED group's policy in terms of whether they will code a fracture of E&M based on timing of the referral.

  4. #4

    Default 72 hour rule

    It stems from definitive treatment vs. pallative treatment. If the ED physician refers the patient to an ortho within 72 hours, he usually is not definitively treating the fracture, and expects the ortho to treat the fracture. It is frustrating, as many time on a simple fracture, the ED physician states to f/u with ortho in 24-48 hours for a simple fracture, and the patient does not, we lose on the fracture care, however, the physician is also stating in that statement that he is no longer LIABLE for the fracture care. He/She places the responsibility onto the patient. This is something to think about when you code a fracture care code vs. a splint.

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