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Fracture care after ED visit

  1. Question Fracture care after ED visit
    Medical Coding Books
    We are having a discussion in our office regarding fracture care.

    We have a patient that was seen in ED. The ED physician diagnosed the fracture, put on a post mold (not a cast) then sent the patient for follow up with an orthpaedist. Patient comes in - do we charge for an office visit and fracture charge because we will be following the patient for the balance of the fracture care even though on the first visit we did not do anything (such as put on another cast or splint)? We just saw the patient, took an x-ray and advised the patient to followup. Or do we just charge for the office visit and x-ray? We did not reduce or manipulate the fracture in our office, but the ED physician has transferred the fracture care to the orthopaedist.

    Any help you could give me would be appreciated.

    Thank you,

    Denise Turner, CPC
    Munster, IN

  2. #2
    I would say that because there was nothing done regarding replacing the splint (i.e. a cast etc) then you would not qualify for fracture care. Fracture care is for any restorative treatments, x-ray and consult would not be a restorative treatment.

  3. #3
    Columbia, MO
    If the ED physician charged fracture care and then transferred to you can charge the fracture care with a 55 modifier, otherwise it is just the office visit and a V54.x dx code not a fracture dx code.

    Debra A. Mitchell, MSPH, CPC-H

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