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Fracture care - diagnosed

  1. Default Fracture care - diagnosed
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    Our pt was seen at er and diagnosed with a finger sprain and provided a splint and was sent to our office to follow up. Our physician saw the pt several days later and once another set of x-rays were obtained the pt was diagnosed with a finger fracture, but he did not change the splint that was initially applied by the er dr. Is it appropriate for our physician to charge the fracture care even though the er doc applied the splint?
    Thanks

  2. #2
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    Unless your doc actually treated the fx with splint or cast, I would stay away from the procedure codes. Bill only for the E/M and any x-ray services personally provided.
    Jason Steeprow, CPC

  3. #3
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    there are instances that you would not remove a splint if it would cause the fracture to shift. He is still taking over management of that fracture so I would think he could charge for fracture care. I would not charge an E/M because the ER sent the patient knowing it was fractured.
    Susan

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    I agree with Susan. The initial dx by the er was the sprain. The fracture was not identified until the patient was seen in the office.

  5. #5
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    I have to respectfully disagree with Susan and mbort - to code/bill a fracture treatment code - the fracture must be treated - via closed/open - manipulation, without manipulation - but by no means does a confirmation of an xray showing a fracture or taking over care of the fracture without doing anything - constitute a "fracture treatment" procedure code. Which code could you even use for that?
    I agree with coder911. I'd code and E/M for that first visit - and when/if the patient follows up and fracture treatment is "really" given, (some procedure that warrants a procedure code) that's when I'd code out the initial fracture treatment code.
    but that's just me
    Donna, CPC, CPC-H

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    ok--devils advocate here.

    Did the doctor remove the splint to take the x-rays?

    Because the doctor does not "change" the splint (saves the ins and pt money) does not mean that he is not providing fracture care does it?

    He did put the same splint back on the patient right (unless of course it was never removed for the x-ray? Did he advise the patient of the care that was needed for this fracture that was not initially diagnosed by the ER?

    Would you really wait until the patient returns in two weeks for a re-x-ray and actually receives a new splint to charge for fracture care?

    In the 18 years I have been coding for orthopedics, once the fracture has been identified is the appropriate time to bill for the fracture care (yes, providing treatment was rendered). I have never waited until a return visit to charge the fracture treatment that was identified weeks ago, this is only prolonging global days etc, so in essence you are raking in on the E/M's and then capturing the fracture code at a later date. My theory is "its now (when fx is identified) or never" for capturing the fee.

    Just my two cents
    Mary

  7. #7
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    yes, I'm with you on that mbort -"providing treatment is given" ... from the info given I assumed the provider didn't remove the splint or reapply it. Maybe I read it wrong... You'd be correct though, if treatment was given. However, if only the xray was done, confirmed fracture, taking over care - and no fracture treatment was given I still stand on the E/M code. How can you code a fracture care procedure code if it wasn't done? what code would you use if nothing was done but an xray and confirmation? I think the patient AND the insurance company would frown upon services being billed that weren't actually given!

    so, you'd actually code a procedure code even if nothing was done? what code would you use and how would you justify it?

    yes, I'd wait however long till (if) the patient came back and had another xray - and re-splint before charging out a procedure code that wasn't really done. More often than not, finger fracture patients usually don't return (unless they're really messed up, open fracture etc). Initial care is usually an xray and little splint, (rarely follow doctors orders) and rarely return UNLESS it gets worse. And if they do come back, I might only be charging out an E/M and splint application! Not fx care - depending

    of course this is my response ONLY IF fracture care wasn't given! ONLY if all the provider did was confirm fx on xray and office visit.

    if fracture care was given, of course a fracture care code or E/M splint/cast application would be appropriate
    Last edited by dmaec; 07-18-2008 at 03:26 PM.
    Donna, CPC, CPC-H

  8. Default
    I agree wholeheartedly with Donna. If the patient is coming to our office in a splint that was provided by the ED and our provider reads x-rays that were taken by the ED confirming the fracture and our provider is not changing anything that was initiated by the ED--only continuing with the splint, I would be charging the E&M service only. If the patient returns at all (they don't always, even if the provider expects them to), we can charge another E&M service. If our provider was the one to initiate the splint or if he/she changed anything about the original treatment by the ED provider, I would charge fx care. It's all a judgment call--and again, we need to remember that neither way we bill (either fx care or E&M) is incorrect.

    ~L
    CPC, CGSC, COSC

  9. #9
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    Its all about supporting documentation. Unfortunately on here, the most trivial piece of documentation thats not mentioned can make or break our decisions.

  10. #10
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    fracture care involves managing the fracture, not just applying a splint or buddy taping fingers. If the patient is sent to us by the ER and they have already identified a fracture, we do not charge an E/M code, just the fracture care. Maybe a splint has already been applied that we do not want removed for another week or so. We are still taking over management of that fracture, which means if that fracture shifts, we may have to change plan of action.
    If the patient comes to us and the fracture is not confirmed by the referring doctor, then we will charge an E/M and then the fracture care.

    Susan

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