# Fracture of great toe, toe and metatarsel



## pnwcoder (Jun 29, 2011)

I'm new to fracture care so here's my question. 
IMPRESSION:  Closed fracture secondary to blunt trama, left foot, with fractures of the distal and proximal phalanges of the great toe, fracture through the neck of the great toe metatarsal, and comminuted fracture of the distal phalanx of the second toe.
RECOMMENDATIONS:  I discussed the problem with ------ and I believe that we should treat this with a short-leg posterior splint.  Because of his pain medication use to this time, I think we will treat this with OxyContin 20 mg b.i.d. with oxycodone 5 mg 1 every 4 hours as needed for breakthrough pain.  Continue with the methadone, which has been taken at this time, and return to my office in 10 days for followup evaluation.  We will probably change this to a short-leg cast.  He is going to be discharged with crutches.  He has been asked to ice the dorsum of the foot over the next 24 hours.

Dr selected consult code (documentation doesn't meet requirement) and fracture care of great toe, 2nd toe and metatarsal. There is a VERY limited exam so if I code fracture care I wouldn't code e/m level. I'm not sure if this qualifies for fracture care (codes: 28470, 28490-TA-59, 28510-59) since it doesn't sound like he was involved with splinting, he just said should be treated with splint. Provider does f/u with this patient and applies short leg cast so should I code ER visit as e/m and then start fracture care at f/u office visit? So confused


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