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fracture coding advice please!

  1. Red face fracture coding advice please!
    Medical Coding Books
    What is the appropriate coding for treatment of minor fractures in the family physician's office that consists of an x-ray, pain management and application of an air cast or other pre-fabricated splint, that does not require an Orthopedic consult and only prn follow up with the family physician? Some physician's want to code it as fracture care but with the limited amount of care and follow up, it seems to me it should be an E/M code with the supply code for the air cast or pre-fabricated splint. Application of a cast/splint doesn't seem correct to me either, since it is applied by the nurse and is pre-fabricated. Thank you in advance for your advice, we appreciate it.

  2. #2
    Default
    There is debate over when it is appropriate to only bill E/M vs fracture care. I would usually advise providers to report the fracture care unless it was a very simple fracture (such as a finger/toe fracture) where they were just taping it and there was no follow up required. Otherwise, I would have them use fracture care codes- there is always an increased liability/risk for the Physician who is treating a fracture and the RVU's incorporate that into the fracture care codes (this liability/risk is not factored into the E/M codes).

    IF you do bill the E/M and the splint is "pre-fabricated" and there is no work except for slipping it on or giving it to the patient for them to put on then I would not bill out the application code but I would report the supply code. If provider or staff is applying a splint made from fiberglass/plaster roll then I would report the appropriate application code along with the Q supply codes.

    If you are reporting the fracture care codes then of course the application is incuded but you can still bill for the supply.

    If you do report the fracture care codes you would not be wrong - but using your discrection you may feel more comfortable reporting just the E/M. I would query the provider and find out the risk, severity and potential outcomes of the fracture in question to determine which way to go.

    Hope this did not confuse you more!
    Christina Musser, CPC

  3. Default
    Thank you for your input. This is exactly what we believe as well.

  4. #4
    Location
    Greeley, Colorado
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    Default
    I believe you CAN code for the initial application of a pre-fabricated splint. See page 139 of the CPT Professional edition. I used to code ED and we always coded for the application.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    High Point, NC
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    Default
    The supply codes for the majority of the pre-fab splints include "fitting & adjustment" in the description so you cannot bill separately for the application for these. The application codes are for use when applying a custom/molded splint or cast from plaster or fiberglass, etc.
    Cindy Gallimore, CPC, CENTC

  6. #6
    Location
    Greeley, Colorado
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    Red face
    Quote Originally Posted by cgallimore View Post
    The supply codes for the majority of the pre-fab splints include "fitting & adjustment" in the description so you cannot bill separately for the application for these. The application codes are for use when applying a custom/molded splint or cast from plaster or fiberglass, etc.
    You are so right. I don't know what I was thinking. You would only code the application if using fiberglass or plaster.
    Lisa Bledsoe, CPC, CPMA

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