# New to Ortho-need fracture care help!!



## Snflwr (Jul 23, 2010)

I am new to ortho coding w/ no one to train me on correct ortho coding.  My issue is this, pt was seen in ER and a volar short arm splint was applied sent home and then came the next day to see my ortho doc. What was filled out on the fee ticket for the visit by the doctor was a 99203(we have never seen the pt before so is new), 25600, A4580, A4565 and 73100.

Then, pt has returned 2 wks later and doctor fills out fee slip as follows, 99024, 29075, A4590, 73100.

I am confused on whether or not we can bill for this cast and just fracture care in general.  Can anyone please help on the correct codding for this.  Thanks


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## nyyankees (Jul 23, 2010)

HalleyNohr said:


> I am new to ortho coding w/ no one to train me on correct ortho coding.  My issue is this, pt was seen in ER and a volar short arm splint was applied sent home and then came the next day to see my ortho doc. What was filled out on the fee ticket for the visit by the doctor was a 99203(we have never seen the pt before so is new), 25600, A4580, A4565 and 73100.
> 
> Then, pt has returned 2 wks later and doctor fills out fee slip as follows, 99024, 29075, A4590, 73100.
> 
> I am confused on whether or not we can bill for this cast and just fracture care in general.  Can anyone please help on the correct codding for this.  Thanks



Did ER doc bill out fracture care since he/she applied the splint? What did your doc document in his notes for 25600?


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## Snflwr (Jul 23, 2010)

I have no idea if ER billed fracture care and not stated in doctor note, as for his note he said will place pt in a sugar tong splint x about 2 weeks.  Then we can convert this to a short arm cast x 4 weeks.  The sugar tong splint will be more comfortable for her as it will limit supination, pronation.  The patient has evidence of some very mild carpal tunnel syndrome probably related to swelling and irritation of the median nerve.  This should resolve on its own.   Today a sugar tong splint was applied. 

 Impression - Non-displaced interarticular fracture of the right distal radius

This is all that is mentioned in note regarding the care.  Thanks


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## DRWINGCHUN (Jul 23, 2010)

Was your question answered?


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## Snflwr (Jul 23, 2010)

Not yet.


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## DRWINGCHUN (Jul 23, 2010)

OK, correct me if I am wrong.
Your physician originally billed 25600 and then two weeks later, patient is placed in cast.
So, are you questioning whether this was the first cast or not?

This is a little tricky but I think that we can get to the bottom of this.
Please contact me at drwingchun@aol.com so that I can discuss more with you.
It appears that surgeon may be using alternate method of fracture care coding.


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## schimpf (Jul 23, 2010)

*billing manager*

The ER Dr usually doesn't charge fracture care, but doublecheck
1. make sure  modifier 57 was applied to ov at initial visit
2. cannot charge for cast on same day as fracture care, but you can charge for the casting material
3. when patient returns for follow-up visit and a new cast is applied you can charge for the cast with a 58 modifier.
I've been coding Ortho for 20 years..Get to know your modifiers very well.
If you have any other questions or need help don't hesitate to email me or call 973-626-0912
Good Luck
Darlene Schimpf


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## nyyankees (Jul 23, 2010)

HalleyNohr said:


> I have no idea if ER billed fracture care and not stated in doctor note, as for his note he said will place pt in a sugar tong splint x about 2 weeks.  Then we can convert this to a short arm cast x 4 weeks.  The sugar tong splint will be more comfortable for her as it will limit supination, pronation.  The patient has evidence of some very mild carpal tunnel syndrome probably related to swelling and irritation of the median nerve.  This should resolve on its own.   Today a sugar tong splint was applied.
> 
> Impression - Non-displaced interarticular fracture of the right distal radius
> 
> This is all that is mentioned in note regarding the care.  Thanks



ok..this would be enough for 25600 since he took x-ray, applied splint and will have follow-up in a few weeks. You can bill out cast application afterwards as I would apply 58 modifier as it would be done in 90 day global period. What I look for in fracture care is fracture assesment/dx through some type of x-ray, treatment of fracture (splint/cast, etc.) and follow-up care. Hope this helps.


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## Snflwr (Jul 23, 2010)

Darlene, could I get your email address, I did not see it listed in your reply.  Thanks so much


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