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25622 and or 25600

  1. #1
    Johnstown, Pennsylvania Chapter
    Question 25622 and or 25600
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    I have a physician in the ED that did fracture care for a distal radius fracture and a scaphoid fracture (he did not reduce fractures just casted). Can I code both of these CPT cods or should I just code one fracture care code? Both fractures were of the same extremity.

  2. #2
    Nashville AAPC Chapter
    Without knowing more details it is really hard to give a solid answer. It is not typical to code fracture care codes without reductionsint he ED. Typically the E/M captures the definitive care components and then if the ED physician applies a cast the cast application would be billed.

    Usually, most ED bill the reduction CPT codes, because they are not going to be following up post-operatively with the patient. The non-reduction fracture care codes are predominantly post-op follow up as there really was not any surgical care done.

  3. #3
    Johnstown, Pennsylvania Chapter
    In this case I am actually charging the technical component of what the ortho physician did. My charges will not be PC charges for the ED physician.

  4. #4
    Nashville AAPC Chapter
    Without reading the physicians note - it is hard to determine what code would be used. There is a CPT code that treats both the radius and the scaphoid or ulna bones. Read the descriptions carefully, billing two fracture care codes probably would not be correct, especially if they are on the same arm. But, most likely the ED physician is just applying a cast. You would only code for the casting if the reduction was NOT performed, with the E/M to examine the injury.

    There is no TC component to the fracture care for profee. The TC side is for facility only. From your first querry you were asking about the physician, so I read it as profee. We only bill for the physicians work on the profee side. There must be a manupulation in the ED by the physician to code a fracture care code, otherwise if the cast documentation is appropriate, that is all you can bill.

    If you bill a fracture care code without manipulation you are denying the orthopedic physician any recoupment of payment if he needs to bill the fracture care code. The ED physician will not do postoperative followup.

  5. Default Type of Care
    I'm trying to understand the scenario with technical component for orthopedic care. If the Orthopod met the patient in the ED and casted the patient there, I'd say fracture care would be billible with a 54 modifier. But I agreeee with M in seeing no technical component except the cast itself as a supply.
    But I wouldn't say that Fracture Care always requires manipulation in the ED to be coded. Often the care rendered in the ED is definitive for fingers, toes etc with after care with orthopod or primary care doc. In these cases a fracture care would be appropriatte with a 54 mod without manipulation. I would agree with Michelle that definitive care is rare with larger fractures like the Radius. But I have occasionally seen it in the ED with restorative ( not just a temporary splint) casting and then follow up. Again that could be coded with the fracture code with 54 which should allow the orthopod to be also paid for follow up care.


  6. Default
    I am billing for the fx care 25600 after the pt was seen in the ER. The ER also billed 25600 w/the 54 modifier. Our ortho is being denied pmt as POST OP pmt included in the sx. Any ideas on how to get the Ortho paid?

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