# Charging for fracture care and surgery



## camillehud (Jan 12, 2010)

We charged for fracture care when a child was initially seen in the office. On this visit, the doctor decided to take the child to surgery to do a distal radius percutaneous pin fixation. How do you code for the surgery since the fracture care creates a global scenario? Do we do a corrected claim???


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## mbort (Jan 12, 2010)

camillehud said:


> We charged for fracture care when a child was initially seen in the office. On this visit, the doctor decided to take the child to surgery to do a distal radius percutaneous pin fixation. How do you code for the surgery since the fracture care creates a global scenario? Do we do a corrected claim???



yes I would send in a corrected claim.


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## sgoodknight (Jan 12, 2010)

If on 01/01/2010 the doctor sees the patient for the first time for a fracture and during that visit determines to take the patient to the operating room to repair the fracture.  You should bill an appropriate E/M service with a 57 modifier (if surgery done same or next day).  Then you would bill the surgery CPT on 01/02/2010.

This is how I would code it.  

: )


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## camillehud (Jan 12, 2010)

*Surgery Scheduled Several Days later*

What if he scheduled the surgery several days later? And what do we do about billing the fracture care on the day of the E/M?


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## mbort (Jan 12, 2010)

camillehud said:


> What if he scheduled the surgery several days later? And what do we do about billing the fracture care on the day of the E/M?



Since the decision for surgery was made on that initial visit, you can only capture the E/M visit and casting.  You should send in a corrected claim reflecting that and then bill the surgery on the correct DOS.


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## FTessaBartels (Jan 12, 2010)

*More details, please*

Can you give us some more details?  A time line would be helpful ... date of first visit and what services provided; date of second, third, etc visit; date of surgery.

I'm just not sure whether fracture care was actually provided on first date of service, or when surgery took place (same DOS or subsequent).

F Tessa Bartels, CPC, CEMC


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## mbort (Jan 12, 2010)

I read it as.

child was seen for fracture in office and even though surgery was scheduled based on that initial e/m, they accidently charged for fracture care.  Am I reading the original post correctly?


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## camillehud (Jan 12, 2010)

*More Details*

The doctor saw the patient on 01/05 and surgery was performed on 01/11
Notes are as follows:

EXAM:   This patient is in a sugar-tong splint, which was removed for treatment and inspection of the abrasion on the dorsal aspect of his wrist.  The patient was placed in finger trap suspension for that effort.  A new bandage with Telfa was applied with Neosporin ointment.  His sugar-tong splint was reapplied and aces were used loosely.  

XRAY/S:
  X-rays taken at the hospital on 01/03/2010 showed a displaced and impacted distal radius fracture, probably Salter II configuration.  The fracture line is oblique in a volar direction from the dorsal epiphyseal line through the metaphysis.  

DIAGNOSIS: 813.42-DISTAL RADIAL FRACTURE
719.43-PAIN IN JOINT, FOREARM
813.43-FX DISTAL ULNA-CLOSED 

ASSESSMENT:    Percutaneous pinning should be considered because of the oblique nature of this fracture and the need for stability as this patient is approaching the end of his growth in this area.  

PROCEDURE/S:
 99204-25-NEW OFFICE/OUTPATIENT VISIT,
25565-RT-TREAT FRACTURE RADIUS & U 

PLAN:    This patient will be scheduled for a closed reduction with percutaneous pin fixation for his displaced Salter II fracture distal radius.  Risks and benefits have been explained at length and all questions have been answered.  

So how do we code the surgery since it's in global?


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## prince21 (Jan 13, 2010)

After reading the note I have to agree that a corrected claim needs to be submitted for the first encounter.  The decision for surgery was there, so Em plus casting would have been appropriate for the first visit.


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## caroline75771 (Jun 4, 2010)

I have the same scenario.  Would the following apply ~meaning only bill an em/57 and cast even though closed reduction seemed to fail and decided  sugery? Thank you,

Billed: 6/2/10-99223 & 27818
6/3/10- 27822
HISTORY OF PRESENT ILLNESS: The patient is a 78-year-old female complaining of right ankle injury. The patient had tripped over a puppy today injuring her right ankle. She had immediate pain and inability to ambulate. She is brought to White Plains Hospital Emergency Room. X-rays showed a fracture. She has a history of hypertension. She lives in Florida and she has a visiting her family in New York for her grandson's graduation. She is a previous independent community ambulator. 

PHYSICAL EXAMINATION: Physical exam shows elderly white female lying in a hospital stretcher in mild distress. Right ankle has posterior deformity and pain with range of motion. There is tenderness. She is actively move her toes. Vascularity is good and skin is intact. There is generalized tenderness. 

X-rays of the right ankle show trimalleolar fracture with posterior subluxation of the talus. Intravenous sedation was given and closed reduction was performed but the ankle was noted to easily sublux posteriorly after reduction. A short leg fiberglass cast was applied with attempt to hold the reduction. Post reduction x-rays of the right ankle showed continued posterior subluxation of the talus in the trimalleolar fracture. Right trimalleolar ankle fracture subluxation. After risks and benefits of surgery versus nonoperative treatment were discussed with the patient she wished to proceed with surgery for open reduction and internal fixation of the right ankle. Informed consent was obtained for surgery with risks explained including but not limited to infection, blood loss, neurovascular injury, failure of fixation and posttraumatic osteoarthritis. She understands and is willing to proceed. The patient will get medical evaluation for clearance for surgery. The patient is NPO after midnight tonight for possible surgery tomorrow. The patient will elevate her ankle take analgesics as necessary. Cast was bivalved to accommodate any swelling. Please refer to the medical doctor's consult for the remainder of the history and physical examination.


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## caroline75771 (Jun 7, 2010)

please, any suggestions?


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## caroline75771 (Jun 9, 2010)

*Fx care and surgery*

Please need your assistance...Thank you....
Would the following apply ~meaning only bill an em/57 and cast even though closed reduction seemed to fail and decided sugery? 

Billed: 6/2/10-99223 & 27818
6/3/10- 27822

Visit of 6/2/10-
HISTORY OF PRESENT ILLNESS: The patient is a 78-year-old female complaining of right ankle injury. The patient had tripped over a puppy today injuring her right ankle. She had immediate pain and inability to ambulate. She is brought to White Plains Hospital Emergency Room. X-rays showed a fracture. She has a history of hypertension. She lives in Florida and she has a visiting her family in New York for her grandson's graduation. She is a previous independent community ambulator. 

PHYSICAL EXAMINATION: Physical exam shows elderly white female lying in a hospital stretcher in mild distress. Right ankle has posterior deformity and pain with range of motion. There is tenderness. She is actively move her toes. Vascularity is good and skin is intact. There is generalized tenderness. 

X-rays of the right ankle show trimalleolar fracture with posterior subluxation of the talus. Intravenous sedation was given and closed reduction was performed but the ankle was noted to easily sublux posteriorly after reduction. A short leg fiberglass cast was applied with attempt to hold the reduction. Post reduction x-rays of the right ankle showed continued posterior subluxation of the talus in the trimalleolar fracture. Right trimalleolar ankle fracture subluxation. After risks and benefits of surgery versus nonoperative treatment were discussed with the patient she wished to proceed with surgery for open reduction and internal fixation of the right ankle. Informed consent was obtained for surgery with risks explained including but not limited to infection, blood loss, neurovascular injury, failure of fixation and posttraumatic osteoarthritis. She understands and is willing to proceed. The patient will get medical evaluation for clearance for surgery. The patient is NPO after midnight tonight for possible surgery tomorrow. The patient will elevate her ankle take analgesics as necessary. Cast was bivalved to accommodate any swelling. Please refer to the medical doctor's consult for the remainder of the history and physical examination.


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