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E/m visit vs fracture follow up

  1. Default E/m visit vs fracture follow up
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    Hi I need help with fracture billing. An ortho has a pt who came in with a metarsal fracture, treated in the ER. After 3 visits, all of which were billed as 99212 instead of an ortho follow up code pt was advised to ease out of her boot. About a month later pt came back for pain and upon x-ray it was discovered that pt has a 2nd fracture that had previousely been missed. Visit was again billed as 99212. My confusion is when can the provider decide that he is going to do all visits E/M instead of fracture care? Any help is appreciated!
    Stacey CPC

  2. #2
    I would think they can choose to code fx care when ever there is a new diagnosis of a fracture or change in the treatment of the fracture. That is the way that I do it. The MD can choose to either charge E&M or fx care when closed treatment with no manipulation is the course of treatment. Here is a good reference site from the AAOS that I like to refer to.
    Hope that helps
    Tina Wosmek CPC, COSC

  3. Default
    Thank you, the article is very helpful. I can understand why it is controversial.

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