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Thread: Fracture care in the ER

  1. #1

    Default Fracture care in the ER

    AAPC: Back to School
    Need some help.....If a patient comes to the ER, sees an ER physician for a fracture and then get refered to our ortho dept for follow up..who bills what?
    The ER doc is billing for fracture care and then our ortho docs get stuck with the follow up care (which they can't bill for due to the 90 post-op). Ortho wants the ER to bill the ER E&M and let them bill for the fracture care because the ER doc is not doing any follow-up..is that correct? Or can the ER bill for the fracture care but needs to add a modifier? and if they can bill that what does ortho then bill??

  2. #2
    Join Date
    Apr 2007
    Louisville, KY


    Appropriate use of Mods -54 & -55 should help some. It's convincing providers to enter into the "agreement" and of educating their staff that poses the largest challenge in my experience.

    Maybe this'll help you.

    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  3. #3


    well, the er doctor should not be billing fracture care b/c they are only seeing the patient one time and not following up on the patient, plus they are referring that patient to the orthopedic doctor. the er doctor in my opinion should bill ER E/M charges and let the ortho charge the fracture care code. I am sure are some ER docs that bill fracture care code but like i said in my opinion that is not correct.

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