# Closed tx of tibial fx, w/o manipulation - 27530



## renakirk (Aug 20, 2007)

What kind of documentation is needed to support billing CPT 27530 vs. just an E/M code?  

Example - If a patient with a cast goes to a physician and has an x-ray that confirms a proximal tibial fracture.  The physician does not apply a cast, splint, boot, anything, but advises the patient to continue using the cane and come back if anything should change - would you bill 27530 because the patient has a fracture, or just an E/M?  Are there any guidelines you know of or could provide with regards to these types of situations?  

Thanks!
Rena


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## monica.evans (Aug 21, 2007)

I need a little more info here.  Was it the first time the md saw the pt?  Who applied the cast?  If casting was done in the ED, I would say code it as a fx chg and code the ov with a mod 57.


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## renakirk (Aug 23, 2007)

There was no cast - the patient came in with a compliant of lower leg pain, had x-ray which showed non-displaced fracture.  Nothing was done - no cast, no boot, nothing.  The physician told the patient to continue using her cane, basically take it easy and come back if there was any change.  Would you bill fracture care or an E/M?

Let me know if you need any additional information.  Thanks, Rena


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## renakirk (Aug 23, 2007)

I just got the WHOLE story, to help you in helping me.  The physician is an orthopedic surgeon.  The eldery patient, who uses a cane, is known to him, since on the first visit he billed an established patient E/M and ordered X-rays of her knee.   One month later, the patient had an MRI which showed the old, non-displaced fracture of the proximal tibia (there were no additional visits between the initial visit/X-ray and the MRI).  1 week later after the MRI, the patient returns to the surgeon, who read the MRI, said you have an old fracture, I recommend just using your cane - no additional needs at this time - no casting, no strapping, no crutches, no W/C, nothing new - and that was the end of their encounter for this issue.  For this visit, they did another knee x-ray.  We're unsure as to whether to bill initial fracture care (27530) or another E/M?  

At a local AAPC meeting yesterday, people were saying E/M.  Your thoughts?  Any coding references you can steer me to?

Thank you!


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## PatriciaCPC (Oct 3, 2007)

No fx code should be billed for an old healing fx. Just the e/m and the x-rays seperate should be correct.


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## Kanta.M (Oct 8, 2007)

*e/m code*

 
the fx is old,so keep to e/m code and bill for the the xrays.


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