# Treating fractures and casting



## reichtina320 (Apr 14, 2008)

I have not worked a lot with fractures and casting so I am hoping someone can verify for me if I have this scenario correct....

Patient comes in with nondisplaced distal radius fracture:

The doctor codes:
25600 - fracture care without manipulation
29075 - application of cast
office consult
Q4010 - cast supplies

My thought process is that he cannot code both the fracture care and the application of cast/casting supplies; he should only be coding the fracture care.

Is this correct?

Thanks


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## cbheusman (Apr 14, 2008)

Tina,
You were correct. When billing a fracture package the application of the cast is included in the fracture care code (25600). So you would code the fracture care code and the cast supplies. You can find this info under "Application of Casts and Strapping" in the CPT book.

I also watched a webinar last week on Zimmer's website that discussed whether it was appropriate to bill an E/M code with the fracture code.  It basically stated if this was the only reason for the visit (only one dx) it would be inappropriate to bill the E/M code. It stated if the patient had more than one dx code you could bill this and append the other dx code to the E/M code. I just learned of this and am still trying to find more info on it.

Hope this was of some help. 
Cathy


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## PatriciaCPC (Apr 14, 2008)

Correct Tina - You can however bill the Fx care code w/ out manipulation and the supply code.  
Have a good one!


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## FTessaBartels (Apr 14, 2008)

*E&M plus Fx care*

Don't know if this is really a consult vs a new patient ... but ... assuming the patient has never been seen before for THIS fracture ... you CAN bill an E&M visit with a 57 modifier (decision for surgery). 
F Tessa Bartels CPC


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## reichtina320 (Apr 14, 2008)

Even when the fracture care code states without manipulation?


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## cbheusman (Apr 14, 2008)

Tina,
Even though there is no manipulation the cast application is still included in CPT 25600. I looked up this code in Ortho Coding Companion and it states "According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure." Even though no manipulation this code is still considered to be restorative treatment.

Basically I take this to mean that if you bill the fracture package it is billed with the supply code. This would have a 90 global. If patient comes in for a cast change you would bill the application of the cast and the supplies. (with 58 modifier)

Or the physician can decide to itemize bill in which case you would bill appropriate E/M with the application code and the supplies. There would be no global period. When patient comes in for cast change we bill cast application and supplies. We usually figure out whether to bill the fracture pkg or itemize depending on how many times dr anticipates seeing the patient.

Hope this wasn't confusing sometimes I tend to ramble! 
Cathy


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