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Fracture care done my ED & Ortho doc

  1. Default Fracture care done my ED & Ortho doc
    Medical Coding Books
    I code for the Ortho doc, how would I code the scenario below?

    Pt seen in ED, closed reduction w/o anesthesia, however conscious sedation was done, by ED physician however unsuccessful. Ortho doc was called in to evaluate. Ortho doc attempts another closed reduction, this time w/anesthesia.

    ED phys bills for closed fx trmt care code w/no modifier.

    How do I bill for my Ortho doc? Their both charging the same code.

    Any help would be greatly appreciated! Thanks!

  2. #2
    I do not think the ED doc should be charging closed fx tx

    He didn't do it that's why he called ortho to do it, hows he going to explain that? If I were an auditor I would say why did you call ortho? He didn't reduce it, he can't charge it.

    Maybe the ED doc could get away with aborted procedure, or reduced services.

  3. #3
    Milwaukee WI
    Default Modifier 77
    Ortho is NOT my specialty, but here are my thoughts ...

    I agree that the ED doc probably shouldn't be coding the fx treatment ... but without seeing that note I can't really tell (maybe should have a -52 / definitely needs a -54).

    In any case, if the Ortho doc is performing the exact same procedure use a modifier -77 ... repeat procedure by a different physician.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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