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Can I get some pointers

  1. #1
    Default Can I get some pointers
    Medical Coding Books
    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.

    Daniel, CPC

  2. #2
    Duluth, Minnesota
    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


    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.

    Daniel, CPC

  4. #4
    Duluth, Minnesota
    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
    Thanks so much, gave me some clarity on the fracture coding.

    Daniel, CPC

  6. #6
    Milwaukee WI
    Default On another thread ...
    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

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