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Thread: Fracture Care Coding

  1. #1

    Default Fracture Care Coding

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    Could someone help me (I'm new at coding orthopedics)? If a physician sees the patient in the office for a fracture, orders x-rays which confirm the fracture, but does nothing and does not plan to do anything but limit the patient's activity, pain meds, etc; can fracture care be billed in addition to the office E/M code?.


    Sorry, I posted this in the wrong forum.
    Last edited by mary.mcghee@lpnt.net; 08-20-2010 at 10:34 AM.

  2. #2
    Join Date
    Apr 2007
    will join Pasadena,Ca

    Smile Xrays

    Yes. Put whatever level e/m code and add mod 25..if billing medicare put the physican as the refering physican in bx 17 on the hicfa

  3. #3
    Join Date
    Apr 2007
    Fayetteville, North Carolina


    I believe that if it's the providers intent to manage the patient's fracture, whether a cast is applied or not, fracture care is appropriate. Also, Medicare requires a 57 modifier because the fracture care carries a 90 global, I am not sure about other payers, but I think 57 is more appropriate is you are billing fracture care in addition to an E/M. If the provider doesn't indicate that the patient needs to follow-up, or to just call if the patient has any problems, or just to follow-up prn, then I am not sure that fracture care is appropriate. It all depends on the intent to manage the fracture.

    Stefanie Cramer, CPC
    Sr. Coding Specialist
    Cape Fear Valley Health Systems

  4. #4


    Fracture care : does it necessarily mean there should be a surgery?; I feel it can be any procedural care/service provided in relation to the frature by the physician, is enough to label it as 'Fracture Care'(Ofcourse with certain other criteria to be met). What I am trying to point is the modifier 57 is 'Decision for surgery '. Unless the care lands up for surgery how would we append this 57 modifier.
    This out of ignorance I am asking.

    Well, the 90days care plan is one of the mandatory criteria but it can mean that follow up upto 90days of the fracture care as well, to be sure of the healing status, and not necessarily 90days following surgery; meaning 90days credit being given to the fractured Status than necessarily a 'post surgery status' alone in fracturecare category ,though we have the global rule for surgery sections.
    Just the modifier doubt!
    Thank you.

  5. #5


    How would we append 57 for this fracture care. Fracture care not necessarily to land up in surgery (57 is for Decision for Surgery).Would n't any procedural care/Service suffice ?(ofcourse have to meet the criteria mandated to label as Fracture Care)
    The 90 days follow up plan is a mandatory criteria to code/bill it for F care of course. The 90days credit here in Fcare, I feel, is for the fracture healing follow up rather than exclusively for surgery that should have taken place.
    Could I have some enlighening please?
    Thank you

  6. #6
    Join Date
    Apr 2007
    Fayetteville, North Carolina


    This link might answer you questions:


    Stefanie Cramer, CPC
    Sr. Coding Specialist
    Cape Fear Valley Health Systems

  7. #7


    Thank you very much. It is an amazing site. Yes, that is what I needed to know. Yes, the modifier 25 or 57 depending upon the service/procedure/surgery undertaken.
    Thank you once again

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