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Fracture care without treatment

  1. #1
    Default Fracture care without treatment
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    Patient is diagnosed with Closed fracture of intertrochanteric section of femur (820.21). Decision was made to surgically correct the fracture. After admitting the patient to Hospital, patient refused to be hospitalized. Case d/w husband in detail. He wished to respect wife's decision. AMA paper filled, husband signed the form and was aware of the complications and risks of refusing the surgery.

    Now, the biller was provided with superbill with following codes. 99213-57 & 27238. Would it be right to code the fracture care in this scenario?

  2. Default Omit px + SDX v64.2
    Quote Originally Posted by arme2783 View Post
    Patient is diagnosed with Closed fracture of intertrochanteric section of femur (820.21). Decision was made to surgically correct the fracture. After admitting the patient to Hospital, patient refused to be hospitalized. Case d/w husband in detail. He wished to respect wife's decision. AMA paper filled, husband signed the form and was aware of the complications and risks of refusing the surgery.

    Now, the biller was provided with superbill with following codes. 99213-57 & 27238. Would it be right to code the fracture care in this scenario?
    Omit 27238; Assign V64.2 as SDX to reflect Pt's refusal of Surg Tx. (AMA)

    Thanks
    Last edited by msrd_081002; 01-28-2011 at 07:51 AM.

  3. #3
    Default
    Quote Originally Posted by msrd_081002 View Post
    Omit 27238; Assign V64.2 as SDX to reflect Pt's refusal of Surg Tx. (AMA)

    Thanks
    I know that it would not be correct to bill Fx care code, but here here is what the practitioner said: "bill 99213-57 for the visit with the E & M to evaluate and make a decision to treat the fracture. In this case, because of patient preference, the decision is to treat the fracture without manipulation or surgery"

    If anyone can help with finding official guidlines, that would be helpful. I just need to prove them that it is incorrect.

  4. #4
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    Quote Originally Posted by arme2783 View Post
    I know that it would not be correct to bill Fx care code, but here here is what the practitioner said: "bill 99213-57 for the visit with the E & M to evaluate and make a decision to treat the fracture. In this case, because of patient preference, the decision is to treat the fracture without manipulation or surgery"

    If anyone can help with finding official guidlines, that would be helpful. I just need to prove them that it is incorrect.
    I understand the doc's thinking. But to capture the closed treatment aspect I would think that he would need to document in the patient's records that OUTSIDE of the patient's refusal for an ORIF that he gave instructions as to what do (Outside surgery) i.e non-weight-bearing, PT, splint, cast, etc. If he just documented that the patient refused the open surgery and that's it he will have a hard time winning this battle.

  5. #5
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    Quote Originally Posted by nyyankees View Post
    I understand the doc's thinking. But to capture the closed treatment aspect I would think that he would need to document in the patient's records that OUTSIDE of the patient's refusal for an ORIF that he gave instructions as to what do (Outside surgery) i.e non-weight-bearing, PT, splint, cast, etc. If he just documented that the patient refused the open surgery and that's it he will have a hard time winning this battle.
    well, they gave the instructions "Advised patient and husband to f/u in 1 week.
    Advised patient to remain NWB to promote healing."

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