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Fracture care and E/M

  1. #1
    Default Fracture care and E/M
    Medical Coding Books
    I'm new to Ortho coding and have been having some trouble with it. I bill for just the physician's at a hospital. I recently starting billing for our Ortho clinic, if patient comes in for fracture care and requires reduction how do i determine if i use the E/M with -57 or just the fracture code ? I was told to use just the major surgery codes because we follow 90 day global and the initial visit is included. Patient are referred to us alot so it's usually the first time they are being seen at our facility, so if they are a new patient and require reduction it is truely a decision for major surgery, so would i bill the reduction and E/M with -57 or just the reduction ?

  2. #2
    If the documentation supports it, I would use the E/M with the 57 modifier and the fracture treatment code. There is an awesome article on fracture coding under the orthopedic forum. Unfortunately I dont have time today to look for it, but if you search you'll find that it is a great article.

    Hope this helps.

  3. #3

    Is this the link your referring to ? I read this and yes it was very helpful. I also have another question, for anyone else who views this. I was also told that if a patient come in for fracture care but is sent to surgery that i can bill the E/M visit with -57, how many days before surgery should i put this ? We are a very busy clinic and a patient might be seen on one day and sent to surgery but won't have the actual procedure performed till serveral days later. They are usually seen by the physican and decides to perform surgery and then sent to pre-admit.

  4. #4
    you only use the 57 if the decision for surgery is within 24 hours and yes thats the article

  5. #5
    North Carolina
    Modifier 57: Decision for Surgery
    An E/M examination coded with modifier 57 indicates a visit that resulted in the initial decision to perform a major surgery. It is used the day before or the day of major surgery. Surgeries that have a 90-day follow-up period are considered major surgeries. When coding modifier 57, ensure that the patient’s records clearly indicate when the initial decision to perform the surgery was made.
    Rebecca CPC, CPMA, CEMC

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  6. #6
    Thank you for the input. I have never used -57 for a pre-op exam because of the fact we don't perform the surgery till serveral days later, but i was confused on if the surgery was performed that day. But i did read the articles along with several other ones i have found really helpful. Thanks again on the input, it was very helpful !!

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