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Thread: Fracture Care with E/M

  1. #1
    Join Date
    Apr 2007
    Long Island/New York

    Default Fracture Care with E/M

    AAPC: Back to School
    What are the coding guidelines with an E/M and fracture care (i.e. 23600). Can you bill out an E/M? Does it depend on the documentation in the patient's file? And if so, is modifier 57 more appropriate than 25? Thanks. It's a little confusing and would like clarification. Any links to sites that have godd information is appreciated. Thanks.

  2. #2


    No E & M with fracture care code.

  3. #3

    Wink Fracture care and E&M

    If the orthopaedic surgeon is seeing the patient for the first time, determines there is a fracture, completes the history taking and examination and then goes on to care for the fracture, you would bill:

    E&M - 25
    Care of fracture

    You would ONLY use a -57 modifier if the decision to take the patient to surgery in the next couple of days (or longer) is made during this encounter.


  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default -57 modifier

    I agree with AuntJoyce EXCEPT ...

    You need a -57 modifier. Fracture care carries a 90-day global period so is considered "major surgery" even when it's a closed reduction.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Join Date
    Apr 2007
    Long Island/New York


    I actually found an artcile on Ortho-decision.com that had an article stating E/M's can be billed with fracture care - new or established pt. I found it after posting this thread. Interesting...huh?

  6. #6


    The CPT 23600 has a 90 day global you would use Mod 57 and you can bill E/M if the documentation supports this of course.

  7. #7
    Join Date
    Apr 2007
    Greeley, Colorado


    If the patient comes in with a known fracture (ie was seen int the ER and told to see Ortho within the next day or so), then I would only code the fracture care.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Join Date
    Apr 2007
    Long Island/New York


    Quote Originally Posted by Lisa Curtis View Post
    If the patient comes in with a known fracture (ie was seen int the ER and told to see Ortho within the next day or so), then I would only code the fracture care.
    Yes it always depends on the documentation in the record. But some of our Dr's were not 100% sure if you could at all. That's why I submitted the thread and looked for the info on AAOS and Ortho-decisions.com where I found the info.

  9. #9

    Default Fracture care with E&M

    This is really a very debatable issue...

    ...Modifier 57 and the interpreted definition of major surgery...

    Definition: Decision for Surgery

    Use Modifier 57 when an evaluation and management (E&M) service resulted in the initial decision to perform surgery. Major surgical procedure is defined by CMS as a procedure having a 90-day global period assigned by CMS. The global period includes the 1-day prior to surgery. No documentation is required.

    Modifier 57 is not eligible when used with the E&M code when the E&M visits is for the preoperative history and physical prior to the surgical procedure.

    I think the issue lies mainly in interpreting major surgery...in this case, the care of the fracture, although listed in the surgery section, is truly not major or open...if the decision is for open surgery/major surgery then that is more along the lines of the definition.

    Here is another excerpt...

    MAJOR SURGERY- any surgical procedure that involves anesthesia or respiratory assistance
    surgical operation, surgical procedure, surgical process, surgery, operation - a medical procedure involving an incision with instruments; performed to repair damage or arrest disease in a living body; "they will schedule the operation as soon as an operating room is available"; "he died while undergoing surgery"

    MINOR SURGERY - any surgical procedure that does not involve anesthesia or respiratory assistance

    I've about burned out my brain cells on this one...I am very interested in more opinions...
    Last edited by AuntJoyce; 12-04-2009 at 09:44 AM. Reason: Additional info added

  10. #10

    Default link

    hi can u share the Ortho-decision.com link.

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