CODING CORNER: Restore Order to Your Fracture Treatment Coding

Solve these case studies to report casting with confidence

Knowing bone anatomy and what counts as restorative care can make all the difference in the accuracy and ease of your fracture treatment coding. Use these fracture scenarios to decide whether you’re on the right track or need a refresher course.

Don’t Confuse Application And Replacement
Patient #1: An 8-month-old patient previously underwent bilateral release correction of clubfeet, and the physician placed casts on her at that time. The documentation for the present procedure reads, “Casts were removed. Molded bilateral long casts were replaced.” What should you report?
Solution: For the current procedure, you should report code 29450 (Application of clubfoot cast with molding or manipulation, long or short leg) with modifier 50 (Bilateral procedure), says Lolita M. Jones, RHIA, CCS, an independent consultant specializing in hospital outpatient and ambulatory surgery center coding, billing, reimbursement and operations in Fort Washington, Md.
Warning: You can’t report the initial placement of the casts for clubfeet, because those placements are integral to the correction of the deformity. “But we are dealing with a replacement procedure here,” Jones says. So unless there are insurance limitations, you can report the replacement.
Earn Full Payment for Restorative Care
Patient #2: A patient receives an x-ray in the emergency department that indicates she has a nondisplaced and minor impacted fracture of the left distal radius, which the physician treats with a short arm splint. The physician states, “Patient should continue wearing splint for next 3-4 weeks,” and that he’ll follow up with her on a routine schedule for tic douloureux. How should you report this service?
Solution: Because the physician provided all the care the patient will receive for this injury, you should report 25600 (Closed treatment of distal radial fracture or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation) with modifier LT (Left side). Additionally, you can probably report an evaluation and management (E/M) code based on your facility’s guidelines (99281-99285), given the work involved in discerning the nature of the patient’s condition.
The doctor’s instruction that the patient wear the splint for three to four weeks indicates that the patient won’t receive any restorative treatment or any additional fracture care, Jones says. This documentation justifies your use of 25600. Because you have provided a definitive treatment, you are entitled to bill for that service, even if there is no follow-up, says Caral Edelberg, CPC, CCS-P, president and chief executive officer of Medical Management resources Inc. in Jacksonville, Fla.
Distinguish Restorative From Comfort Care
Patient #3: A 66-year-old patient presented to the emergency department with a Colles fracture with impaction. The physician’s documentation states that she [...]

- Published on 2005-10-11