# 99282 vs 99283 fracture?



## renifejn (Oct 1, 2012)

Pt presents with finger fracture, splint placed, and pt sent home with Motrin.

Comprehensive history
Comprehensive Exam
Low OR Moderate MDM?

Can "closed treatment of a fracture without manipulation" that is moderate be counted for splint placement to make this type of encounter a 99283?


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## OCD_coder (Oct 4, 2012)

There are low level fractures, you do not indicate x-rays being performed.  Placing a splint is considered a minor procedure, but I do understand that closed treatment of a fracture could be considered moderate.

It would really depend on if the ED physician referred the patient to an orthopedist for follow up care.  This would imply that the ED physician was just stabilizing and not really providing restorative care.

This is a highly debated topic and it varies between ED Billing companies.  You are best to dicern what your company prefers.  My personal opinion is, this is a low level fracture when compared to something more significant like an RUJ or humerus fracture.


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## jimbo1231 (Oct 5, 2012)

*Agreed*

I agree with Michelle that ED fracture care coding still varies quite a bit from billing company to billing company. I think many ED specialty companies would argue for a 99283 not so much on the basis of the splinting, but the X-Ray read. There are some companies that will go to 4 in addtion to larger fractures.
I also agree that if the ED doc stabilizes the patient and sends them to an Orthopod that is not fracture care but an E&M plus splinting if the physician did or closely manged the splinting. But basic finger fractures are usually coded fracture care since definitive treatment is provided in the ED.

Jim


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## kak6 (Oct 5, 2012)

I do ED coding and would give the fracture care if the pt was not referred to an ortho w/in 3 days, as long as the provider read or discussed the x-ray w/technition ordered a splint, and provided pain control, that is fracture care and 99282. If pt was referred to ortho 1-3 days then only the splint applies still 99282. If pt was provided a controlled substance (narcotic) pain meds then I would move to 99283.


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## PURNIMA (Oct 11, 2012)

Hi,

Fracture of fingers  and toes normally warrant low moderate level - 99282, if in case any ED medication or prescribed then I would suggest 99283. 

Hope this helps,

Thanks,

Purnima S


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## jplichta (Oct 24, 2012)

kak6 - is there a way that you track the patients that get referred to ortho within the next 3 days? what if the patient was referred but never went? In the area that I currently work out of most of the cases are not coded as fracture care in the ED but rather given to ortho although we do not have a time frame on them.


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