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Thread: Proper fracture care coding

  1. #1

    Exclamation Proper fracture care coding

    AAPC: Back to School
    Kelly Smith CPC,

    I work in a pediatrics office and we do fracture care. My question is: a patient comes into our office and sees a physician and the phycisian's diagnosis is a fractured distal radius, per our x-ray, but the limb is to swollen to cast and they are told to come back in three days for casting. My understanding is that when they come in on the first initial visit and we do not cast then we code an office visit, x-ray, ace bandages and a splint with the proper modifiers.

    When the patient comes back for the initial casting with a different physician and that physician places the cast for the fractured distal radius, then it is my understanding that we code the CPT global fx on this visit.

    Can you charge a global CPT fx code if on the first day the patient comes in and you place the child in a splint. Your expertise would greatly be appreciated in regards to fracture care. Thanks, Kelly

  2. #2

    Default Fracture care

    Hi kelly,

    its my understanding you charge the fracture care code whenever the cast is intially put on regardless of when they were first diagnosed with the fracture.

    hope this helps.

  3. #3
    Join Date
    Apr 2007
    San Antonio, Texas

    Default Fracture care

    Straight from the CPT book Guidelines:


    Musculoskeletal System

    Application of Casts and Strapping

    The listed procedures apply when the cast application or strapping is a replacement procedure used during or after the period of follow-up care, or when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient. Restorative treatment or procedure(s) rendered by another physician following the application of the initial cast/splint/strap may be reported with a treatment of fracture and/or dislocation code.

    A physician who applies the initial cast, strap or splint and also assumes all of the subsequent fracture, dislocation, or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes. (See notes under Musculoskeletal System, page 75.) A temporary cast/splint/strap is not considered to be part of the preoperative care, and the use of the modifier 56 is not applicable. Additional evaluation and management services are reportable only if significant identifiable further services are provided at the time of the cast application or strapping.

    If cast application or strapping is provided as an initial service (eg, casting of a sprained ankle or knee) in which no other procedure or treatment (eg, surgical repair, reduction of a fracture, or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate.

    Listed procedures include removal of cast or strapping.
    Diana Wilson, CPC. CPMA, CPC-I
    PMCC Instructor

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