# Coding for Aftercare



## jennylynh (May 15, 2013)

Hi,

I am under the impression that when you have a fracture, any aftercare (check to see if bone is healing well) needs to be coded with a V code.  Should the V code be the primary diagnosis with the fracture code as the secondary?  

Thanks!


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## dclark7 (May 15, 2013)

No you would only use the V code for aftercare.


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## jennylynh (May 15, 2013)

Hi Doreen,

Yes, that is what I meant.  For any aftercare (x-ray to check healing, follow-up visits) in the healing stage, it would be a V code...


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## cwilson3333 (May 23, 2013)

*V codes for Fracture Aftercare*

I still bill the fracture code , followed by V54.89.  I have not had any problems with being denied on submitting my claims this way.

Would like some feeback on this.

Thanks,
CW


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## nyyankees (May 23, 2013)

cwilson3333 said:


> I still bill the fracture code , followed by V54.89.  I have not had any problems with being denied on submitting my claims this way.
> 
> Would like some feeback on this.
> 
> ...



I would make the V code the primary code as it is a V code that can be used as a primary.


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## mitchellde (May 23, 2013)

cwilson3333 said:


> I still bill the fracture code , followed by V54.89.  I have not had any problems with being denied on submitting my claims this way.
> 
> Would like some feeback on this.
> 
> ...



You NEVER bill the fracture code after the initial treatment for the fracture.  You use only the V code for healing fracture.  Every time you use the fracture code you indicate that in addition to the healing fracture , the patient now has a new acute fracture.  This happened to a patient years ago and they were denied employment as the prospective employer requested to see the their patient profile from the insurance since the job was extremely high risk.  The patient profile showed numerous fractures but the patient actually only had one.  The dx codes belong to the patient so always code the diagnosi from that perspective, your codes can and do cause harm to the patient when they are incorrectly applied.


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## nyyankees (May 23, 2013)

mitchellde said:


> You NEVER bill the fracture code after the initial treatment for the fracture.  You use only the V code for healing fracture.  Every time you use the fracture code you indicate that in addition to the healing fracture , the patient now has a new acute fracture.  This happened to a patient years ago and they were denied employment as the prospective employer requested to see the their patient profile from the insurance since the job was extremely high risk.  The patient profile showed numerous fractures but the patient actually only had one.  The dx codes belong to the patient so always code the diagnosi from that perspective, your codes can and do cause harm to the patient when they are incorrectly applied.



wrong diagnosis can affect when a patient goes for insurance (i.e. life insurance).


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## cwilson3333 (May 24, 2013)

*V codes Fracture Care*

So, V code only ?

Thanks,
CW


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## mitchellde (May 24, 2013)

Yes V code only


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## cwilson3333 (Jun 5, 2013)

*V Codes*

DMitchell,

Can you let me know of any good articles on V-Coding, not only for fractures, but post-ops,
etc.?

Still not sure I agree with posting V Code for fracture care first, especially when patient is also xrayed on the follow-up orthocare appt, and the actual date of injury is on the claim, which should tell the insurance this is not a new fracture???  Just my train of thought, which I know is not the way I am supposed to be billing. 

Do you bill  global care [90 days]  for your fracture patients?

I also find it easier to bill itemized charges, i.e. e/m visit plus xray versus doing a global fracture code and fee.  I find most patients get upset as they don't understand global fracture care, and especially the one-time fee they see on the EOB, and the fact that it is listed as a surgical code.

Just brushing up on my coding and would like some input on how other ortho coders are handling their billing.

Thanks


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## mitchellde (Jun 5, 2013)

Coding clinic 3rd quarter 2000 I believe was the year stated that after the initial treatment of the fracture the fracture can no longer be used it must be coded as what it is, ie, a healing fracture which is the v 54.- code or non-healing or malunion which are specific codes, but what it is not is an acute fracture.


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## Treetoad (Jun 13, 2013)

I work for a trauma group---we see a LOT of worker's comp cases.  I understand what the real coding rules state, However, I tend to see a lot of denials when I use the V-code.  They're looking for the acute diagnosis.


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## dclark7 (Jun 13, 2013)

While it is not considered correct coding, most of the workers comp carriers that I have dealt with and especially the carrier for Federal Employees require you to use the diagnosis code that was approved for the injury no matter how far out you are.


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