tldixon@mokancomm.net
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We need some guidance, and we also need to know how the choice of codes affects reimbursement.
It is very difficult on our older patients with vertebral compression fractures to decide whether they have pathological fractures due to osteoporosis or traumatic fractures. In many cases, the underlying diagnosis of osteoporosis, steroid-induced osteoporosis, etc., won't be definitively established until after later work-up. For purposes of the trauma program, we do not consider falls from standing height in older individuals to be traumatic fractures. But insurance companies may view it differently. One case in point is the patient we currently have in the hospital. She had an L1 compression fracture due to a fall against a sink from standing height, having been jumped on by a dog, and she has previously diagnosed alleged osteoporosis (studies done elsewhere years ago, so we don't have the studies.) Is this a pathological fracture due to osteoporosis or a traumatic fracture? For purposes of our trauma program, a patient like this wouldn't get in the registry because it would not be considered a traumatic fracture. Also, what are the reimbursement ramifications? If a patient like this needs a kyphoplasty to retard progression of deformity and control pain, do insurance companies and Medicare cover the procedure for both pathological AND traumatic fractures or not????
I would appreciate any and all feedback regarding this issue....my Orthopaedic Surgeon is in a quandary regarding these issues.. We are getting ready to open up a Trauma Center in our ER, so we really need to have these questions answered before all this happens.
Thank you,
Terri D. CPC
It is very difficult on our older patients with vertebral compression fractures to decide whether they have pathological fractures due to osteoporosis or traumatic fractures. In many cases, the underlying diagnosis of osteoporosis, steroid-induced osteoporosis, etc., won't be definitively established until after later work-up. For purposes of the trauma program, we do not consider falls from standing height in older individuals to be traumatic fractures. But insurance companies may view it differently. One case in point is the patient we currently have in the hospital. She had an L1 compression fracture due to a fall against a sink from standing height, having been jumped on by a dog, and she has previously diagnosed alleged osteoporosis (studies done elsewhere years ago, so we don't have the studies.) Is this a pathological fracture due to osteoporosis or a traumatic fracture? For purposes of our trauma program, a patient like this wouldn't get in the registry because it would not be considered a traumatic fracture. Also, what are the reimbursement ramifications? If a patient like this needs a kyphoplasty to retard progression of deformity and control pain, do insurance companies and Medicare cover the procedure for both pathological AND traumatic fractures or not????
I would appreciate any and all feedback regarding this issue....my Orthopaedic Surgeon is in a quandary regarding these issues.. We are getting ready to open up a Trauma Center in our ER, so we really need to have these questions answered before all this happens.
Thank you,
Terri D. CPC