# Fracture care vs splints



## schacko (Aug 2, 2008)

Hello...

Could anyone suggest when it would be appropriate to code fracture care..
Eg: Patient being diagnosed with a wrist fracture from a fall and a sugar-tong splint is applied and is asked to follow-up with orthopedics..Would code to fracture care or splint applied or both..?? 

What documentation do you look for inorder to assign a fracture code...?

Pls reply with informative feedbacks...

Thanks in advance..


----------



## Treetoad (Aug 2, 2008)

I'll tell you how we handle it at our office.  If this fracture was diagnosed and splinted at the ED, the ED department charges for the splinting and possibly for an E&M service.  The patient is referred on to our orthopedic service, ususally within a day or two.  At this time, our service is taking over the care of this fracture.  Our service will either charge non-op fracture care w/ or w/o manipulation (according to which bone is fractured) or if the patient needs to go to the OR, we'll charge the appropriate E&M service with modifier 57 (if the surgery is pending that same day or one day later).  Occasionally, we itemize bill for each visit separately.  Usually we do this if the fracture is very minimal and our provider doesn't really change the way the fracture was originally treated at the ED (such as "continue with splint and observe" will follow up).

Opinions differ greatly on the use of non-op fracture care and itemized billing.  Understand that either way is correct.  In some cases, fracture care is more beneficial and other times, itemized billing is beneficial.

Also, we are a hospital based practice.  (I don't know if that matters at all.)


----------



## DSchrlau (Aug 2, 2008)

I agree with above but if you are referring it to a orthopedic you shouldn't charge fracture care because fracture care means you are agreeing to treat the fracture through the globel period.


----------



## dmaec (Aug 2, 2008)

I'd code it as a splint application and E/M visit with a modifier. Based on what you posted - the provider who applied the splint has no intentions of following up with this fracture.  This is obvious from what you wrote: "wrist fracture from a fall and a sugar-tong splint is applied and is asked to follow-up with orthopedics.". The ortho that they're telling the patient to follow-up with should get the fracture care code and his follow-up visits will be global visits.  Your provider simply provided initial contact/review and comfort to the patient while referring to another who is more advanced in handling the fracture care.

When I code for fracture treatments, I make sure documentation supports a fracture treatment code.  I read the note to clarify if the patient is being made comfortable only and moved on to another, (in those cases I tend to code the appropriate E/M and cast/splint application) or if the provider who is applying the initial cast/splint is going to be the one following the treatment of this fracture. (in these cases, I code out the appropriate fracture treatment code *IF* and only if fracture treatment was actually done)

In our facility, fracture treatment codes are used when definitive fracture treatment is given and going to be follow-up by that same provider (same practice).  Documentation needs to support the fracture treatment. If our providers simply assess the fracture, make the patient comfortable and send them to another provider for treatment, they mark an E/M and application. (of course, again, documentation supporting)
_{this is my understanding, opinion & advice on the posted matter}  _


----------



## amolson1325 (Aug 2, 2008)

By your documentation it sound like the doctor didn't do anything for the fracture except put a splint on....there for, I would think you would just code the splint and leave the fracture repair (if any) to the orthopedist. ??


----------



## mbort (Aug 3, 2008)

Shirley,

Who are you coding for..hospital, ER doc, Orthopedic specialist?


----------



## schacko (Aug 3, 2008)

*Danks a lot!!*

Hey!

A bunch of thanks to all my friends out there for the information provided.... 

Well I code for ER doc..Sometimes documentation makes a lot of difference and is sometimes confusing when assigning a fracture care code...


God bless you all...!!


----------



## FTessaBartels (Aug 5, 2008)

*ER should use fracture care*

Shirley,
In our setting, the ER doc does not use fracture care codes at all because these codes carry a 90-day global period and the ER physician is not going to be following the patient. The ER might put on a splint, but they don't typically reduce the fracture. 

If your ER doc is *truly* providing fracture treatment (not just diagnosing, putting on a splint and referring to Ortho), then the fracture code would be billed with a -54 modifier (surgical care only).

F Tessa Bartels, CPC


----------



## schacko (Aug 6, 2008)

*Thanks once again!*

_Thanks Tessa..Now the picture is very clear..

God bless you!!_


----------

