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E&M With Fracture Care

  1. Post E&M With Fracture Care
    Medical Coding Books
    Is it correct coding to Code for a E&M when billing for Fracture Care? I have a Ortho Doctor that will bill a E&M with the DX for 729.5 when a Fracture is billed.

  2. #2
    North Carolina
    Typically, you can bill an E/M with fracture care if:

    1. The E/M occurs on the same day of or the day before the surgical procedure.

    2. The E/M service directly prompted the surgeon's decision to perform surgery. (Modifier 57-Decision for surgery)

    3. The surgical procedure following the E/M has a 90-day global period. In your case, fracture care.

    Normally, you don't need a different DX (in your case-729.5) for the E/M to be paid but some carriers can be problematic. (Appeal in this case).

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