# Closed treatment fracture codes



## chealey (Aug 1, 2013)

I'm not that familiar with orthopedic coding and was wondering if I could get some clarification on when it's appropriate to use fracture treatment codes.  In the example below the MD billed 27780 "closed treatment of proximal fibula fx w/o manipulation".

Any help would be most appreciated.

Thank you


RADIOGRAPHS:  X-rays show a nondisplaced transverse fracture through the mid shaft of the fibula.  No other fractures are seen.


ASSESSMENT AND PLAN:  This is a 30-year-old male with a right midshaft fibular fracture. Fortunately, it is a stable injury.  There is no evidence of any knee or ankle injury.  He can be weightbearing as tolerated and wean off the crutches as tolerated.  This should continue to heal well.  He is to restrict his activities to things that do not hurt, and after 4-6 weeks can progress back to his regular activities, but certainly needs to wait to play basketball for another 6 weeks. All questions answered


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## Richard Sigler (Aug 5, 2013)

FX care codes should only be used where the pt will be seen back at least 3 times. The FX care code also includes the first cast application but not the cost of the materials. There is a 90 day global period with each of these care codes. Each OV after the initial is a 99024 and any services such as a new cast and x-rays are billable. 

With the note that you have posted I would not use a FX care code.

Hope this helps you!


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## chealey (Aug 6, 2013)

Thank you so much for this information.  So if the fracture does not need to be immobilized with a cast or splint, but the patient is expected to return for follow-up to assess the healing, is it o.k. to use the closed treatment codes w/o manipulation in that situation?


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## scooter1 (Aug 8, 2013)

Clear up fracture care confusion by asking these two questions
by: DecisionHealth Staff
Published Jul 1, 2002
Clear up fracture care confusion by asking these two questions
When you're plagued with a tricky non-manipulative fracture care case, ask yourself these two questions:

1. Will any restorative treatment or procedure(s) (eg, surgical repair, closed or open reduction of a fracture or joint dislocation) be performed or are they expected to be performed? If yes, then bill as a fracture care code such as 25662. If no, then bill as E/M service with appropriate cast/splint application code and supplies if furnished.

2. Will the same physician assume all subsequent fracture, dislocation, or injury care? If yes, then bill as a fracture care code such as 25662. If no, then bill as E/M service with appropriate cast/splint application code and supplies if furnished.

The answer to these questions will help lead you to the correct coding choice. Case in point: A patient presents to the emergency department (ED) with a left forearm fracture. The ED physician applies a short arm cast and tells the patient to follow-up with an orthopedic physician. In this instance, the ED physician should charge for the appropriate E/M service and cast application since the answer to the second question is NO and the ED physician is sending the patient on to another provider for ‘definitive' care. The same would be true if the patient comes from their PCP's office and is being sent on for ‘definitive' care. 

The problem is many times the ED or PCP wants to bill the global component of the fracture treatment when there was NO intent to ‘treat' the patient but just to evaluate and manage the patient and send them on to a specialist for definitive treatment and care. Orthopedic offices have a hard time if the ED or the PCP bills the global fracture care code and then the orthopedist tries to bill it and it gets denied as a duplicative service.

 “And don't forget to cross walk your fracture care code to the appropriate Q-codes. Remember to charge for those casting supplies,” says Margaret Maley, a consultant from Chicago-based KarenZupko and Assoc.

Take for instance this question AMA's CPT Assistant December 2001 answered for a reader: “My physician saw a patient for a non-displaced tarsal bone fracture, which did not require manipulation. Rather than applying a cast, the physician gave the patient a prescription for a prefabricated short leg removable cast, which the patient filled elsewhere. My physician will be providing all follow-up fracture care and will check the fit of the removable cast at the first follow-up visit. Can this be reported as fracture care?”

The AMA's answer: “From a CPT coding perspective this would be reported using code 28450, Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each. In this case, the physician has determined that there is a fracture, decided on the appropriate course of treatment, and is providing the associated follow-up fracture care, so he is meeting the requirements for reporting the fracture care code.”

Now, let's put a twist on all of this. Let's say another physician from another practice is taking your calls one evening. The covering physician sees a patient and calls your physician at home who recommends closed reduction and cast application. The covering physician performs this service. What is billed when that patient comes to your office in 7-10 days?  Since the covering physician performed a ‘global service' for this clinic, the correct coding would be to bill the appropriate fracture care code with modifier –55 appended to indicate your practice is now providing the post-operative care.  If subsequent casting is performed then you need to make sure you bill the appropriate cast application codes and casting supplies rendered.


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