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E/M and fracture care code

  1. #1
    Default E/M and fracture care code
    Medical Coding Books
    One of my physicians is stating a new patient E/M code is not appropriate to bill with a fracture care code. I have always heard they are billable together w/modifier 57 on E/M code. What is the rule? thx
    EG

  2. #2
    Location
    Lafayette, LA
    Posts
    12
    Default
    It is billiable - Some insurances may not pay for an E&M on the same day as a procedure. Modifier -57 states "An E&M service that resulted in the initial decision to perform the surgery may be identified by adding -57 to the appropriate level of E&M service". Hope this helps!
    Last edited by aklein; 01-10-2011 at 01:27 PM.

  3. Default
    Quote Originally Posted by eguest View Post
    One of my physicians is stating a new patient E/M code is not appropriate to bill with a fracture care code. I have always heard they are billable together w/modifier 57 on E/M code. What is the rule? thx
    EG
    Yes it is billable, and yes, you add 57 mod on the E/M code with any procedure code that carries a 90 day global. So in this case a fracture care code, which all fx care codes that I know of carry a 90 day global period.

  4. #4
    Default
    Just be sure your documentation supports the E&M code and the fx code. Also some payers want a 25 even though the fx code carries a 90 day global. You know how those crazy payer rules are sometimes.

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