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Fracture sent from e.r.

  1. Question Fracture sent from e.r.
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    I have a dilemma.What would the proper way to code this.A physician sent over a consult to our orthopaedic physician.This patient was diagnosed with a fracture of the proximal humerus.Our physician saw the patient for the fracture and assumed the fracture care.The treatment for this fracture is a sling.He told the patient to follow up in three weeks and ordered a different sling for the patient.The patient has Highmark insurance.The consult was billed at #99243-25,the fracture care at #26600-RT.The mother called in and complained about the bill.She states that the physician did nothing for her daughter,and wasn't happy about bill due to she has a high deductible.Should there have been a modifier on the #26600-RT for post operative care only.Would it be better to charge the patient for individual visits instead?What is the correct way to code this?
    Also we had a patient who had her leg fixed in another state, but had our physician do her care when she was here for college.

  2. #2
    Columbia, MO
    If the patient was sent to you for treatment of a known fracture then you cannot bill it as a consult. And from what you have given here it does not sound like you have a significant E&M. It is entirely possible that you have only the fracture carre code. Also you state it was a fracture of the proximal humerous but 26600 is for Closed treatment of metacarpal fracture, single.
    I would have coded the fx care only.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default Fx care and consult

  4. #4
    Columbia, MO
    I understand, however just because the steps are there does not mean it is a consult. It would be a consult if they were unsure as to whether it was a fracture or not or if they were unsure as to what should be done. But the referring physician had identified the fracture and sent the patient to you for fracture treatment. This is a referral of care and is not a consult. Then to be able to justify a visit level and the fracture care you need something in the documentation that shows the physician went beyond what is necessary for fro the care and treatment of the fracture. Comprehensive HPI and ROS is not enough, it needs to be something in the exam that is significant and aprt fom the examination of the fracture. Without the note it is hard to say for sure, I am saying that in all likelihood you have fracture care only.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    On a closed treatment of the fracture, where the patient is already in a cast, splint or sling and your doc doesn't change anything, the provider has the option of either charging individual visits if he wants or fracture care. Did the first doctor already charge for the fracture care or just an E/M??? Was the mom complaining about the consult or the fracture care or both??
    [COLOR="DarkOrchid"]Barbara Fontaine, CPC
    2011-2015 AAPCCA [B]Past Board of Directors Chair

    COLOR="Blue"]Assume Positive Intent...Be Kind!

    Past President St. Louis West Chapter


  6. #6
    I would agree with "Mitchellde" - it is up the doc if he wants to charge fx care or not. Typically my docs have a policy on when to charge fx care. We do not charge it if patient comes to us already dx with fx and our doc does nothing (just sling,or brace) we have this policy for exactly the problem you are raising.......patients get mad that they have a thousand dollar bill and the doc did "nothing". we usually only charge fx care if we dx and actually do something ...manipulate...castings...this is our internal policy

    I also would not have charged consult......ER/urgent docs dont usually request consults.....they are asking you to take over care and "treat" .

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