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26740 Is this right? My son was seen at dr - Small avulsion fracture by the knuckle

  1. Default 26740 Is this right? My son was seen at dr - Small avulsion fracture by the knuckle
    Medical Coding Books
    My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

    Thanks,
    Sherry, CPC

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    Quote Originally Posted by sherryjean27 View Post
    My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

    Thanks,
    Sherry, CPC
    Hello,
    Yes dr can bill for fracture care 26740.
    According to CPT guidelines, fracture care is billed as a packaged service. This means that at the time of initial care, a bill is generated that includes:
    1. Evaluation of the fracture
    2. The first cast or splint application
    3. 90 days of normal, uncomplicated, follow-up care.

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    WOW. That is unbelievable. We are charged this for 2 velcro straps.Ouch!! Thanks for the reply

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    I believe that using 99070 for the strapping and an appropriate E/M code would have been more appropriate based on the information you give and the information in the CPT book page 139, next to last paragraph (if no other procedure was performed.)

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    Sorry, I should have let you know that I am using the AMA 2010 CPT book for my answer.

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    thank you for your reply also. That is what i think it should be. Does anyone else have any comments on coding this scenario? Thanks so much

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by sherryjean27 View Post
    My son was referred to an ortho for a fractured finger. (Small avulsion fracture by the knuckle.) The dr used 2 velcro straps and wrapped them around my sons fingers. Does this qualify for a 26740? Please help if you can.

    Thanks,
    Sherry, CPC
    Unfortunately, the physician can bill for fracture care...but not for any f/u visits for 90 days. Personally, I have an issue with finger and toe fracture care codes when the fractures are so benign. But technically, these can be billed. Be thankful that your son didn't have more than one fractured finger, because the description of this code states "each", so you could have been charged for each finger!
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Location
    Kansas City, MO
    Posts
    51
    Default
    I agree with Lisa - technically fracture care can be billed for. Our physicians don't generally bill for that with fingers and toes though unless significant intervention is involved as it seems unreasonable to bill such a high fee for such a simple treatment. I would probably discuss it with the physician if you follow up.

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    I would agree that a general ortho would probably disagree w/ coding the fracture code, but if you asked an ortho w/ subspecialty in hand, they would most likely agree with the global fracture care coding. There is much more to the hand w/ all the tiny nerves, vessels, muscles than what we sometimes think of. If we lost ROM or had residual nerve damage after a finger fracture, we wouldn't feel it was so minor.

  10. #10
    Default
    So one could use 26740 instead of the general E/M with a 25 modifier and a fracture cast/splint?

    Peace
    ?_?

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