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Thread: Definitive Care/fx care

  1. #1

    Question Definitive Care/fx care

    AAPC: Back to School
    Hello everyone,
    I was hoping some experienced ortho coders could direct me to some solid information on definitive care guidelines. A chart I am reviewing, pt went to ER for hip fx and discharged home; then to private MD who then referred him to orthopod...The orthopedist charged a consult visit level 4 along with fx care.

    To me it looks like a consult only, somewhere along the line the patient was set up with home physical therapy which began prior to seeing the orthopedist, the orthopedist states in the impression "patient may continue the home physical therapy". The orthopedist is seeing this patient in consult 11 days after the initial ER visit.
    Help me to clearly understand how a provider can charge a consult charge and a fx care charge when the fx was previously managed elsewhere?
    Any good articles out there?
    Last edited by sharonrose; 03-18-2010 at 10:29 AM. Reason: misspelled word

  2. #2


    I guess I would want to see the orthopedic note before answering the question. I wonder why the private MD was involved, other than for insurance purposes? I work for a group of orthopedic surgeons. We get patients all the time who are referred for fracture treatment.....sometimes surgical and sometimes non-surgical. The only time we may charge a consultation (non-Medicare patient) is if one of our providers actually goes to the ED. Otherwise, we normally would consider it a "transfer of care". But having the private MD involved complicates it a little bit.


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