I can understand your confusion! First, go to your CPT coding guidelines for the section on casting, splinting and strapping. Clear as a bell that the only time you can code casting, splinting or strapping by itself is when it is A)the initial and only service for the fracture or dislocation AND your doc will NOT be charging for any subsequent definitive care such as surgery, or reduction. The E & M visit can be separately reported, with the application of the support for the fracture or dislocation. Or, B) if during or after the 90 day global the patient breaks his cast or splint or removes his strapping, or the original cast got too loose and had to be redone, or the patient needs a different type cast to do the job, you can bill for the casting/splinting/strapping as a replacement.
Fracture care begins as soon as the doc begins medical care for the fracture or dislocation.
But fracture care doesn't just imply use of a code with a 90 day followup.
A non-displaced fracture or dislocation can be billed one of two ways: you can bill separately for each E & M visit and the initial application of the cast/splint/strapping, including each of the follow up visits and xrays to check on the progress of the fracture, and avoid the global fracture period altogether. This is good for a situation in which the patient will be back only a few times. Or, the global fracture/dislocation care concept can be used, where any fracture code can be billed as appropriate, whether or not there is manipulation, or surgery and application of any type of support is bundled into the fracture care code. You can bill the first E & M visit and bill the fracture care code on the same day, but you will need to append modifier 57 to the hospital admission, if the doctor made the decision to operate, or append mod 25 if the documentation criteria allows you to. The patient may come back in for treatment and have xrays to check on the healing of the fracture and you would bill only for the xrays or supplies used in putting on a replacement cast, or for the splint itself. Naturally a return to the OR for complications of surgery are billed separately outside the global fracture care. I don't know if this helps.
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