"A large number of variables affect which codes are assigned," explains Cathy Klein, LPN, CPC, senior consultant with Health Care Economics Inc., a consulting and practice management firm in Indianapolis. "Family practice coders need to be able spot four elements and integrate them into the overall service provided."
Four Elements Involved
When reporting fracture care, coders should peruse the FPs notes carefully, reviewing the four areas:
1. Identify the fractured bone. The Surgery/Musculoskeletal System section of the CPT manual is organized by body part. Codes that describe procedures of the upper arm begin with 23930, for instance, with fracture care appearing as a subset and encompassing codes 24500-24685. Pelvis and hip joint codes begin with 26990, with fracture care encompassing 27193-27266.
Because there are numerous codes in this section and all fracture codes are not centralized in one spot, coders will need to search through each category to find the codes assigned for fractures.
2. Determine if reduction is open or closed. "Reduction is a term physicians use to describe how they put the affected bone back into proper position," says Kathleen Mueller, RN, CPC, CCS-P, an independent coding and reimbursement consultant and educator based in Lenzburg, Ill. "There are several methods physicians can use to accomplish this."
These methods include closed reduction or treatment, which means no incision is made, or open reduction, which indicates that the physician made an incision near the affected bone to reposition it. "A physician will sometimes treat the fracture percutaneously, which simply means he or she will insert some type of treatment device through the skin," Klein says.
For example, a simple fracture of the femur may be coded 27500 (closed treatment of femoral shaft fracture, without manipulation). If an incision is required, it may be reported with 27507 (open treatment of femoral shaft fracture with plate/screws, with or without cerclage).
Generally speaking, FPs treat fractures that only require a closed reduction. Open or percutaneous reductions are usually referred to an orthopedic surgeon.
3. Establish if manipulation is used. When deciding whether to use an open, closed or percutaneous reduction code, coders must note if the physician manipulated the bone to set it. Methods of manipulation may include twisting or pulling on limbs or joints, or applying pressure near the point of fracture, Mueller says. Most fractures treated by family physicians do not require manipulation.
In the example above with a broken leg, for instance, 27500 describes the service without manipulation. But, 27502 is defined as closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal [...]