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laceration/fracture

  1. Default laceration/fracture
    Medical Coding Books
    I am having trouble coding cpt procedures when a patient comes in the ER with an open fracture to a finger and it is sutured and a splint applied for the fracture are both of these procedures codeable and if so is a modifier applied?
    Thanks for all your help!

  2. #2
    Location
    Swainsboro/Statesboro, GA
    Posts
    754
    Default Fracture coding
    It is my understanding that the initial splinting, casting or strapping are included with the fracture care code and should not be coded separately. Please see the subsection guidelines "Application of Casts and Strapping" in the CPT manual. This is in the Surgery/Musculoskeletal section.

    If you are coding the open fracture CPT code (such as 26735), I would not code the suturing separately.
    Freda Brinson, CPC, COC, CEMC
    AAPC Swainsboro/Statesboro Chapter
    2017/2018 Secretary/Treasurer
    2016 Education Officer
    2014/2015 President
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)
    brinsonfr@sjchs.org

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Code open fracture care with modifier -54 (surgical care only) if the patient will follow up with another provider (if coming back to the ED for suture removal no mod -54 and suture removal will be at no charge) OR code the suturing and splinting/casting with supplies (if following up with another provider and not returning to the ED).
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Nashville AAPC Chapter
    Posts
    937
    Default Lac repair/open fracture
    Did the MD do a reduction of the fracture?
    If you have a lac repair of say 12001, the CCI edits eliminate your use of a splint code. Only, a 25 modidier is needed on the E/M code.

    If you have a reduction code of 26725 you would apply the 54 modifier to this CPT and a 57 to the E/M code.

    More information is helpful when asking question such as what codes are you using and whether or not this is a repeat visit.

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I do not see a CCI edit for 29130 and 12001.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
    Nashville AAPC Chapter
    Posts
    937
    Default CCI edit
    We don't know what code was used for the open fracture/lac repair. If a volar splint was used (29125) this is included in the CCI edits with 12001 and cannot be used.

    I agree, if a 29130 is used, it is not in the CCI edits with 12001 and can be used with a 51 modifier, unless this patient is Medicare then other rules will apply.

    Not enough information to give a good answer to this question, there are many different answers applicable.

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