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Fracture Care billable w/consult?

  1. #1
    Location
    Kansas City, MO
    Posts
    51
    Question Fracture Care billable w/consult?
    Medical Coding Books
    We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.

  2. Default
    Quote Originally Posted by debwoods65 View Post
    We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.
    The 57 modifier is put on an E&M code when billed with a procedure code that carries a 90 day global period.
    It has nothing to do with going to the OR.
    So yes it is right to bill a consult/E&M code with 57 modifier when billing for fracture care done in an office setting.

  3. Default
    Modifier 57 or 25 for fracture codes.
    Instead of reading the descriptor"as decision for surgery", you please read it as"service that resulted in the decision for closed treatment". Now you are very much justified to append 57.

    Thanks to Stephanie who gave the web site in her post.

  4. #4
    Location
    Kansas City, MO
    Posts
    51
    Default
    Thanks for the input.

  5. #5
    Default
    http://www.paorthosociety.org/resour...dingCorner.pdf

    Here is a great site that gives lots of senerios for fracture coding.
    Tina Wosmek CPC, COSC

  6. #6
    Default fracture care
    Tina-

    I was unable to access info. Is there somewhere specific on the PA ortho website to click?

    thanks!

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by debwoods65 View Post
    We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.
    If a patient is sent to the ortho with a known fracture, I think only the fracture care should be coded. If it is questionable and the ortho has to do more E/M type work, then you should code the E/M with modifier -57 and also the fracture care. This is just my opinion...and I welcome all feedback!
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Location
    Ft. Myers City of Palms
    Posts
    3
    Default
    It's my understanding if the ortho physician diagnosis the fx, then he can bill the E/M with a -25 and the fx care. But if the pt is being referred for a known fx then I would bill for the fx care only.

  9. #9
    Location
    Greeley, Colorado
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    2,045
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    Quote Originally Posted by rharvel View Post
    It's my understanding if the ortho physician diagnosis the fx, then he can bill the E/M with a -25 and the fx care. But if the pt is being referred for a known fx then I would bill for the fx care only.
    I agree. This is what I meant for my post to relay. (But use mod -57)
    Lisa Bledsoe, CPC, CPMA

  10. Default
    my personal rule of thumb is "if it has a 90 day global, use 57 mod; everything else gets a 25 modifier."

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