AAPC - Back to school
Results 1 to 3 of 3

Thread: Fracture Care Globals in Pediatric Practice

  1. #1
    Join Date
    Apr 2007
    Ogden Utah

    Exclamation Fracture Care Globals in Pediatric Practice

    AAPC: Back to School
    We are having a discussion in our office as to just when fracture care begins. The providers are under the assumption that if they apply a splint, they are not assuming fracture care, but once they place a cast, they have assumed fracture care. Even if the splint was applied by the same provider who then casts the patient. We do have some providers who are emergency after hours only, and I can see continuing to bill that way in their cases as they will not be doing the casting, only initial splinting/stabilization, hence they are technically providing the same services as an ER doctor. However, when the patient is seen by a provider who has regular hours, fracture is diagnosed and clearly stated, splint is applied to stabilize injury pending decrease in swelling, and the patient comes back in 3 days, I have been taught that fracture care was assumed on that first visit/splinting due to the fracture diagnosis and stablization being performed. The casting would merely be a staged procedure as not all fractures require casting for treatment.
    Am I correct in wanting to bill out the fracture care with the first visit when an xray is reviewed, fracture is clearly stated/diagnosed, and stabilization started? The office has been billing an E&M along with splint application for the first visit and fracture care for the next if a cast is applied. If the patient is only splinted, they are not billing fracture care.
    I do realize that there are some simple fractures that it is better to just do the E&M's and splinting with no global billing, but this is specifically relating to fractures with higher RVU's that are not being referred out to an Orthopod.
    As this office a pediatric practice, emergency and regular, they do first treatment on many patients. I do realize that this is the orthopod forum, but as I am coming across difficulty in discussing this in our office as they keep stating that ortho has 'different rules' than pediatrics. I was taught that rules are rules are rules.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default When are you treating the fracture?

    I am NOT an Ortho specialist, BUT ...

    It seems to me that you will never have just one answer to this. The key question is WHEN are you treating the fracture?

    As you've no doubt noted, there are fractures that require only splinting (or even just buddy-taping - e.g. a broken toe). If the splint is the definitive fracture treatment, then code the fracture care and begin your global period. On the other hand, if you are just providing a temporary stablization and comfort before you can adequately evaluate and treat the fracture, code just the E/M & splint application for this first visit.

    It is never appropriate to unbundle the service provided into E/Ms and splinting just because you may get paid more that way. (Although I agree that it doesn't make much sense sometimes how little we are paid for a global package on some procedures.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Ogden Utah

    Exclamation Main issue..

    The main issue we seem to be having on the fracture care global is that we are open 24/7 and have providers who are after hours only or no regularly scheduled hours (coverage for only a few days a month, etc), and the billing of the global due to that circumstance. At that time, I look at it that the provider who falls under that category would only charge the E&M and stabilization, and the provider who sees them next and casts would provide the fracture care (with receipt radiological documentation of a fracture). Though as the practice is large and patients don't always schedule their follow up at the time they are seen with the same provider who just did the fracture care, how do we not create an issue with the other providers who may end up seeing the patient? If one provider does the fracture care and the patient does not return to them but comes back for the rest of the global time to see providers B, C, and D for once each, with the providers paid by RVU's, it's a bit of a quandry to bill the global care fairly.
    Does anyone have any rationales to help with this???

Similar Threads

  1. Fracture Care Globals
    By chelsey71 in forum Pediatrics
    Replies: 2
    Last Post: 06-17-2015, 06:07 PM
  2. Closed Fracture Care and Open Fracture Care
    By kathy a in forum Orthopaedics
    Replies: 6
    Last Post: 07-09-2012, 10:07 AM
  3. OV with Fracture Care & What Constitutes Fracture Care
    By rryder1963 in forum Orthopaedics
    Replies: 1
    Last Post: 03-26-2012, 08:19 AM
  4. looking for a CPC for a Pediatric practice in MD
    By dianaprzy in forum Job Postings
    Replies: 0
    Last Post: 11-12-2010, 11:00 AM
  5. Newborn Care and Neonate/Pediatric Critical Care
    By bobbro in forum Pediatrics
    Replies: 1
    Last Post: 03-03-2009, 03:35 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.