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Orthopedic Coding Alert

Guest Columnist:

Mary Brown, CPC, CMA- Consistency Reigns When Reporting Fracture Care

Casting and E/M or fracture care global codes? A coder shows you the way School is back in session, which for many practices means an increase in playground accidents and sports injuries. Get a head start on coding these services with this brushup on fracture care coding.

Although billing fracture care has probably caused every orthopedic coder some anxiety from time to time, you can rest easy once your office institutes a policy on whether to report global fracture care or to bill E/M visits with casting codes instead.

Trying to switch back and forth can cause confusion and errors, so consistency can alleviate your headaches. When Fracture Care Codes Apply When you're wondering whether it's appropriate to bill fracture care, consider whether the case meets the following criteria:
  You're seeing the patient for her initial visit for the injury.
  The injury is acute (occurred within the last two  weeks). One exception to this could be an undiagnosed scaphoid fracture, which often takes longer to show up
on x-rays.
  Patient has not had surgery for this injury by another physician in a different practice. (For example, if the patient was injured while on vacation, had surgery and now is home and seeking follow-up, you cannot bill fracture care.)
  You plan to care for this injury for the next 90 days. The patient's history should reveal whether the patient was initially seen in the emergency department or another physician's office and later sent to your orthopedic practice for further care of the fracture. If the date of injury is greater than two weeks ago, you should confer with the orthopedic surgeon regarding the billing of fracture care. Some fractures heal quickly, and if the fracture is healed or mostly healed, fracture care would not be appropriate. When You Shouldn't Bill Global Fracture Care The fracture care codes would not be appropriate if the following criteria apply:

1. The fracture is old
2. There is a nonunion of the fracture
3. The fracture is healed or mostly healed
4. Your doctor is NOT going to care for this fracture for the next 90 days
5. No follow-up visits are recommended
6. Patient is scheduled for a more extensive procedure like percutaneous pinning or open treatment with or without fixation. In the above cases, you would bill the appropriate E/M service with applicable casting codes instead of a global fracture care code. If criteria number 6 applies to your patient and you plan to perform the surgery the same date as the E/M visit (or the following day), you should append modifier 57 (Decision for surgery) to the E/M code so the insurer pays it and doesn't bundle it into the surgery code.

If you simply bill casting and an E/M [...]

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