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Closed fx rt and ORIF on lt by two surgeons.

  1. #1
    Default Closed fx rt and ORIF on lt by two surgeons.
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    Patient seen in ER by my Physician A. Patient has fracture distal fib on RIGHT and a trimalleolar fx on LEFT. He treats the distal fib nonoperatively and with walking boot. He refers the trimalleolur fx to his partner phys B and he does ORIF the next day.

    Can we bill the closed tx for phys A and the ORIF for phys B?

    I need documentation for our physician B who states that we cannot bill both. Thank you.

  2. Thumbs up Closed treatment and ORIF...
    From what I can make of the situation, I would say that physician A can bill for the closed treatment of the distal fibular fracure on the right side while physician B can bill for the open reduction internal fixation of the trimalleolar fracutre on the left side.

    Since physician A diagnosed the trimalleolar fracture on the left side and the outcome was that the patient needed surgical intervention, he is correct in not billing any kind of fracture care for this.

    I am at work right now and so it is difficult for me to put my hands on documentation to support this but if I can locate some today, I will get back to you.

    IF the patient had only one fracture and doc A saw the patient for it and diagnosed it but doc B took the patient to the OR the next day, then I would say only the surgery should be billed for doc B and the E&M for doc A - yikes, I think this thought got out of hand but I think it drives home the point (let me know if it does not).

    Hope this helps.

    Have a great day,


  3. Wink Closed treatment and ORIF...
    Actually, I had one more thought...

    If physician A sees the patient say on Monday and diagnoses distal fibular fracture and treats this conservatively (closed management) and also diagnoses a trimalleolar fracture and treats this conservatively (closed management), then he/she would bill for both fractures and fracture care. However, if after say a week or two or six, it is determined that the fracture(s) have either separated, become mal-aligned or are just not uniting apropriately and a decision is made to send the patient to the O.R., then whoever does the surgery will bill for the ORIF.

    In essence, the scenario above would result in closed fracture care of the distal fibular fracture; closed fracture care for the trimalleolar fracture and then open surgical intervention (ORIF) of the trimalleolar fracture.

    Good luck!


  4. #4
    I agree with Joyce.

    Phy A gets e/m and right side
    Phy B gets lt side (you will need a 79 modifier to show that its separate from the surgery the day before with Phy A)
    Mary, CPC, CANPC, COSC

  5. #5
    Milwaukee WI
    Default Modifiers
    I'd also use the LT and RT modifiers as appropriate.
    Or are we not talking about two different extremities?

    F Tessa Bartels, CPC, CEMC

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