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Thread: billing fx care it the pt is only seen once?

  1. #1

    Default billing fx care it the pt is only seen once?

    AAPC: Back to School
    My Dr. saw a pt that we got through the emergancy room. The patient had a pelvic ring fx. Dr did reviewed the x-rays taken from the hospital and his having the patient follow up as needed. Can we bill fx care for this pt, since he is not scheduled to follow up?

  2. #2


    Our group has an oral/maxillofacial surgeon who wants to do this. He sees the patient once and tells the patient to contact the office if there's a problem. Consider this.....most fracture care has a 90 day global period. The charge for fracture care is usually quite substantial (equal to a lot of surgical procedures). Is the work your surgeon providing equivilent to a surgical procedure? What are the chances the patient will have any follow up care at all? Your provider is pretty much taking the "wait and watch" approach. I suppose you could qualify this as non-operative fracture care. Personally, I feel a little funny charging fracture care when there's really not going to be a lot of follow up. If the provider reduced a fracture and planned routine follow up, I would have a different opinion. I guess if it were me, I'd charge the appropriate E&M service. If the patient did come back, the visit wouldn't be global so you could charge another E&M. I expect there are probably a lot of opinions out there in regards to this situation. Maybe someone will give me a reason to sway my opinion in the other direction?


  3. #3
    Join Date
    Apr 2007


    I agree with Treetoad to some degree--however technically speaking, YES, they are entitled to the fracture care. Its really no different than closed treatment of a fractured finger or something simple. They have rendered the treatment, they have given the patient the necessary instruction on care of the fracture and the do's and donts. They have "treated" the fracture. Generally the docs will tell the patient to follow up in a couple of weeks for a repeat x-ray. If the patient decides not to do that, then that was the patients decision.

    We charge the closed treatment of the fracture.

    Hope this helps

  4. #4


    I work for ortho surgeons and in our office if will only charge the fx codes if we know that they will be in for at least one or more visits containing new xrays or reapplications of casts. If he is PRN or discharged I would not reccommend charging out a fx.

  5. #5


    If the physician is not following the pt for the next 90 days, I would not suggest billing fx care.

  6. #6


    Thanks, pdelorenzo. You perfectly summed up the point I was trying to make.


  7. #7



  8. #8

    Default intent

    I believe fracture care is about intent. If the doctor intends to follow up with the patient, then it is perfectly ok to charge a closed fracture.

  9. #9


    Right, the physician intends on treating the pt for the global period! Mary is absolutely correct as well. Sometimes the pt does not follow against our physicians plans (or intent) however, as long as our dictations / medical records indicate accordingly - we're good to bill the non-manipulative fx fees!!!

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