# fracture care



## ggparker14 (Apr 1, 2013)

So confused on fracture care in ED when coding for the physician side.  If a fx is diagnosed and a cast, etc is placed, does the ED physician have to apply the cast, etc to bill E/M plus fracture care?

Thanks for any help.


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## jimbo1231 (Apr 1, 2013)

*No, but*

The physician does not have to place the cast. but they need to order, manage and check on the cast. The key issue about coding for fracture care in the ED is whether palliative care, for comfort until they get to a surgeon, or restorative care, actually treated the fracture are provided. Casting would indicate that restorative care was provided. However if the patient will go to their doc or ortho for follow up modifier 54 should be used to indicate surgical care only. This is usually the case since patients seldom return to the ED for fracture management.

Jim


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## ggparker14 (Apr 1, 2013)

*fx care*

One more question, does the same guidelines apply regardless of what insurance is involved. For instance, if the patient is covered by Medicare, would the same guidelines apply?

Thanks once again.


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## ashack63 (Apr 2, 2013)

*Fracture care*

Was a splint applied or a cast?
Very seldom does an ED physician order a cast. Even when the intent is for restorative care (no immediate follow-up required within 72-96 hours), splints are usually what is ordered.
The most important thing to remember is whether the patient has been instructed to follow up with an ortho within a certain time frame.
Simple fractures (toes, nasal, fingers) are usually the fractures that ED physicians provide restorative care for, with discharge instructions stating follow up with primary or ortho after 72-96 hours.
Without clear restorative care documented, splint charges would be coded.

As far as what insurance is concerned, Medicare wants firm documentation that the provider did a post application Neurovascular check on the splint. Certain splints are also not payable for splint application charges.


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