Results 1 to 6 of 6

Can I get some pointers

  1. #1
    Default Can I get some pointers
    Exam Training Packages
    I code for a family pracitce. Primarly dealing with E/M, and minor surgeries.

    Need some input on how the coding of fractures work.
    What constitues using a cpt code in the closed treatment section on a distal radial fracture in a family practice setting. Versus just applying a cast.

    Clarify this for me.

    Confused
    Daniel, CPC

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Daniel -
    actually either/or can be billed. In our facility, if the provider doing the fracture treatment is going also be doing the follow up, they will bill out the global fracture care procedure code (and Q code for cast/splint supplies).

    if the provider doing the fracture treatment is going to send the patient on to another provider for follow up, (like an ortho), then, that provider will bill out an Office visit (.25 modifier on the OV) with cast/splint application procedure code (and Qcode cast supplies).

    Some providers actually bill out and E/M with application even IF they're going to be doing the follow up care .... (and of course they can bill out and E/M each time because cast app does not have a global period).
    (this can be done though it usually isn't done this way)

    so in short - if they plan on doing the follow up care also, they "usually" bill out the global fx procedure -
    if they plan on just "comforting" them and moving them on to someone else, they "usually" bill out the E/M and application.

    clear things up a bit, or did I just make it more muddy??

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Default Just to clear this up.
    So your saying if my physician I work for does the casting and following up care of a distal radial fracture. With no manipulation. I can bill.

    25600. Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation


    Or

    More commonly just go with the cpt

    29065. Application, cast; shoulder to hand (long arm)
    with an E/M if indicated in the notes.

    Just depends on the situation that arises. Most of the time the family does a casting than shoots them to are Ortho for follow ups. In this case we would just bill the E/M and Casting code.

    On a final note. I can tell the physician that if they decide to do all the care included in the 90 day global. We can code the closed treatment fracture codes with no manipulation. It pays higher than would just billing out a E/M with a casting code.


    Rap this up for me.

    Respectfully
    Daniel, CPC

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    yes, I'd agree with your statement
    (although I wouldn't say it's "more common" to go with the application and E/M codes) EXCEPT apparently in your case it would be - since it seems your provider is simply providing comfort and stabilization and sending them on to another provider for definitive fracture treatment.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. #5
    Default
    Thanks so much, gave me some clarity on the fracture coding.

    Respectfully
    Daniel, CPC

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default On another thread ...
    Daniel,
    I think you also posted this question on another thread regarding a different specialty? Anyway, did I read correctly that you are adding an Ortho specialist to your practice?

    If the ortho specialist is seeing the patient and will be following for the global period of fracture care, then you'd bill the fracture code, as Donna suggested.

    If your family practitioner is seeing the patient because - for example - "she fell off the swing and her arm hurts," and your doc discovers a fracture but is going to send the patient to the ortho specialist for treatment, then your doc would code the E/M and casting/splinting as provided. If the transfer to ortho is happening all on one day, you might be coding only the E/M to the family practitioner (dx pain in arm); and the fracture treatment to the ortho specailist (dx fracture).

    F Tessa Bartels, CPC, CPC-E/M

Similar Threads

  1. Diagnosis Pointers
    By KaitlynEFitch in forum Diagnosis Coding
    Replies: 5
    Last Post: 02-06-2014, 12:18 PM
  2. Diagnosis pointers
    By pumpkin1279 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 04-18-2012, 10:05 PM
  3. Documentation Pointers
    By AKA whoknows in forum Medicare Regulations
    Replies: 1
    Last Post: 07-30-2010, 02:02 PM
  4. Could someone give me some pointers
    By ASC CODER in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-13-2010, 08:35 AM
  5. ICD 9 pointers
    By mmendoza in forum Medicare Regulations
    Replies: 5
    Last Post: 09-03-2008, 11:08 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.