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FX DX on ORTHO CLAIMS-Followup Visits

  1. #1
    Location
    Fayetteville,NC
    Posts
    23
    Question FX DX on ORTHO CLAIMS-Followup Visits
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    Patient seen in office & is treated for fracture-we bill CPT fracture code of 25500 along w/casting materials and DX is 813.23.

    Now patient returns for globalfollowup visits & CPT is 99024, but what should be primary DX on these followup visits? Do we continue to apply the initial FX DX of 813.23 as primary on 99024 as well as any x-rays done?


    Or, should we be coding a "V" code for "aftercare of healing fracture" on followup visits and x-rays as primary?

    Or should we continue to code initial FX DX of 813.23, with "V" aftercare DX as 2ndary?

    Any help much appreciated!

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Per coding clinic 3rd quarter 2001, once the fracture has been treated it is no longer an acute fracture but by definition a healing fracture, so you no longer use the 813.23 code at all use the V code for healing fx. Also coding guidelines support this.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Fayetteville,NC
    Posts
    23
    Default
    Debra,

    Thank you for your response. To be honest your reply is exactly the way I have been handling all followup FX visits. Since FX DX noted at time of initial treatment of that fracture it is to be assumed the fracture is now "healing" and by coding actual FX DX's over & over again on each followup visit appears to insurance carriers as if we are treating "a new" fracture again & again.,however, my immediate supervisor stated we needed to code the initial FX DX on each followup exam as well as on "x-rays" in order to get paid by insurance carriers...???....I want to take your response with me to a meeting w/my supervisor & immediate director to show them I was coding appropriately.
    Has anyone had problems however getting paid by insurance carriers when billing the "V" AFTERCARE OF HEALING FRACTURES" when x-rays are being done at each of the followup-visits during the 90 day global surgical period?? X-rays are still billable during the global period,correct?

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    "Has anyone had problems however getting paid by insurance carriers when billing the "V" AFTERCARE OF HEALING FRACTURES" when x-rays are being done at each of the followup-visits during the 90 day global surgical period??"

    -No, our carriers pay for these services w/ the "V" code


    "X-rays are still billable during the global period,correct?"

    -Yes as well as recasting and casting supplies

  5. #5
    Location
    Fayetteville,NC
    Posts
    23
    Default
    Rebecca & Debra,

    Thanks alot!!!! I had a rough morning and being new to Orthopedic coding and trying to learn the "rules" specific to this specialty in regards to coding can be somewhat confusing. I want to do the best job possible & I tend to second guess my hunches which causes more confusion!
    Your quick replies are "greatly" appreciated!! Thank you so much....this website thru AAPC is awesome! I'm glad we coders have access to this tool/site!

  6. Default
    "Has anyone had problems however getting paid by insurance carriers when billing the "V" AFTERCARE OF HEALING FRACTURES" when x-rays are being done at each of the followup-visits during the 90 day global surgical period??"

    -No, our carriers pay for these services w/ the "V" code


    My office does NOTget paid for the v code being primary. We use the fx code then the V code as secondary

  7. #7
    Default
    I bill aftercare V codes all the time. I have never had a probelm with getting them paid- except for work comp or other 3rd party payors because they pay based on the dx code for specific injury.

    Hope that helps a little

  8. #8
    Location
    Columbia, MO
    Posts
    12,570
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    Quote Originally Posted by banderson77 View Post
    "Has anyone had problems however getting paid by insurance carriers when billing the "V" AFTERCARE OF HEALING FRACTURES" when x-rays are being done at each of the followup-visits during the 90 day global surgical period??"

    -No, our carriers pay for these services w/ the "V" code


    My office does NOTget paid for the v code being primary. We use the fx code then the V code as secondary
    You absolutely cannot bill the acute fx code after the fx has been treated. Again the dx is the patient's not the physicians. Coding guidelines support this as well as coding clinics. The dx is the V code for aftercare for healing fx. I do know that some payer contracts state that they do not pay for xrays for healing fxs they pay for the acute fx only. But this does not mean you use an acute fx code to "get the claim paid"! And truely you have submitted an incorrect (fraud?) claim since the documentation will not support an acute fx.
    Billing dx that are not documented is one of my soapboxes so I will climb down now, thank you!

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by banderson77 View Post
    "Has anyone had problems however getting paid by insurance carriers when billing the "V" AFTERCARE OF HEALING FRACTURES" when x-rays are being done at each of the followup-visits during the 90 day global surgical period??"

    -No, our carriers pay for these services w/ the "V" code


    My office does NOTget paid for the v code being primary. We use the fx code then the V code as secondary
    Not an issue for us; not to mention it is correct coding guidelines!

    Debra...I personally love it when you get on your "soap box"!!
    Last edited by RebeccaWoodward*; 08-04-2010 at 08:06 AM.

  10. #10
    Default V codes
    I have been studying for my COSC exam and learned that you are suppose to use V codes with fx codes for follow up visits, but you can't automatically use the V code for healing fx unless the doctor specifially dictates that the fx is healing. You would need to use a V code for convalescence following tx of fx. for example: for stated healing V54.19-pri dx code/813.23-sec dx code
    if noted stated as healing V66.4-pri dx code/813.23-sec dx code. This is what was on one of the webinars offered by AAPC to help prepare for exam.

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