# Is this fracture care?



## jdibble (Jul 19, 2010)

Any help I could get with this would be apprecaited!

I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit.  I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge.  I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.

1. If the patient was seen as an inpatient for say a pelvic fracture and no surgery is done or manipulations or casting (or any other fracture that nothing physically was performed), but the doctor follows the patient in the hospital and then as OP, would this still be considered fracture care or would I bill each indiviual E/M?

2. From the patient history in billing, the doctor saw the patient for the initial care, but I do not show any other visits posted - would I still bill for fracture care if the patient never returned for follow up visits (assuming it was the patient's decision not to return)?

3. Fracture care includes the first cast, however if the cast needs to be replaced during the global period, how would this be billed?  Which codes would be used and/or casting supplies billed?

Thanks for any help with this - I have to meet with the Ortho office tomorrow and I would like to go in there with some knowledge of what to tell them.


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## Bella Cullen (Jul 19, 2010)

jdibble said:


> Any help I could get with this would be apprecaited!
> 
> I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit.  I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge.  I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.
> 
> ...



1. NO fracture care
2. Yes fracture care if dr actually performed some kind of evaluation of the fx and the first cast or splint application.
3. ex. if this was a Short arm cast I would bill 29075-58 with Q4010 but no Office visit, it would be post op 99024.

That is my opinion on what I would do.


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## nyyankees (Jul 19, 2010)

jdibble said:


> Any help I could get with this would be apprecaited!
> 
> I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit.  I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge.  I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.
> 
> ...



1. Looks like just E/M since nothing was done (x-ray, casting, manipulation, etc.) for the patient. 

2. Fracture care includes and needs follow-up visits as the fracrure care payment includes post-op E/M's in the payment.

3. You can change the cast with supplies (if done in office setting). I use 58 modifier. There's a great AAOS article on fracture care and good CPT Assistant article on cast removal/supplies. Send your email and I'll send over to you.
KM


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## scotta (Aug 3, 2010)

KM, can you send me the article regarding fx care?  scottac@health.missouri.edu  Thanks! Angie


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## denarh40 (Nov 11, 2010)

will you please send me the article too?  Thank you! dbrandt@meriter.com


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## momtosweetpea (Nov 12, 2010)

*Me, too, please!*

I'd be interested in that information also.  Can you please send it to me - cphipps@booneortho.com ?  Thanks so much!


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## Diane Eslinger (Nov 19, 2010)

Me - too.  Please!
I'd also be interested in this article.  Fracture care and recasting always brings up questions.


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## Diane Eslinger (Nov 19, 2010)

Sorry  - forgot email address
diane_eslinger@rsh.net


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## reewriter (Nov 22, 2010)

nyyankees said:


> 1. Looks like just E/M since nothing was done (x-ray, casting, manipulation, etc.) for the patient.
> 
> 2. Fracture care includes and needs follow-up visits as the fracrure care payment includes post-op E/M's in the payment.
> 
> ...


Could I also be sent the link/article from AAOS and CPT Assistant? Thanks so much!
malexander@mainegeneral.org


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## PRINCESSMHH (Nov 30, 2010)

*Me too*

Please send the article to me as well.  mhhobbins@gmail.com 

Thanks~


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## lweygandt (Dec 29, 2010)

Would it still be possible to get this article?  We are acquiring ortho practice which is new to our multi-specialty group and no orth coders.

linda_weygandt@bayhealth.org


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## debwoods65 (Dec 29, 2010)

jdibble said:


> Any help I could get with this would be apprecaited!
> 
> I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit.  I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge.  I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.
> 
> ...






1)  I would disagree with others on this one.  We bill fracture care for closed treatment w/o manipulation (27193) if the doctor is following the patient in the hospital and will follow after discharge.  If no follow up then we would bill the E&M instead.
2) We bill this as fracture care if the patient is _expected_ to follow up with our office. 
3)  We bill using the appropriate casting application code and Q-code for supplies. 

Debbie
Ortho Surgeons, Inc.


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