If you receive only a fraction of your fracture care reimbursement, read these Q & A's to get your coding in line. Make sure your coding guidelines match up with these five answers. Look for Definitive Care Question #1: When should you report fracture and dislocation (F/D) codes for ED physicians? Answer #1: You should report F/D codes (20000-29999) whenever the ED physician performs definitive/restorative care, says Terri A. Brame, CPC, compliance coordinator at Saint Elizabeth Physician Network in Lincoln, Neb. Append these codes with modifier -54 (Surgical care only) because the ED physician generally doesn't provide the follow-up care, she says. Definitive or restorative care is usually the same ultimate care a specialist would provide for that injury, according to the American College of Emergency Physicians in its Orthopedic FAQs at
http://www.acep.org/1,2478,0.html. Experts disagree, however, on what restorative means.
Because the question has no definite answer, you should follow this rule of thumb: Look at what the physician did to the patient, says Eric Sandham, CPC, compliance educator at the Central California Faculty Medical Group in Fresno, Calif.
Ask yourself, "Did the ED physician do everything the orthopedist would have done to the patient barring routine follow-up care?" says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa.
Look out for the following two documentation indications that your ED physician's care was, in fact, definitive, Brame says: The ED physician scheduled the patient for routine follow-up care with a nonspecialist, such as a family practitioner (FP). A patient breaks one of his toes (826.0), for example, and the definitive care is therefore buddy taping. The patient will probably follow up with his FP at the end of 14 days. In this case, you should report the F/D codes for the ED physician, Brame states, for example 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each) with modifier -54. If, on the other hand, your ED physician only provides palliative care so that the patient can go see the orthopedist, you should not report F/D codes. If a patient presents with a severe ankle sprain (845.01) with a lot of swelling and reports shakiness, and the physician, who is not sure whether a bone is broken, splints the ankle and instructs the patient to see the orthopedist as soon as possible, you should only report the splinting, Brame says. You should also report a relevant ED E/M code, if applicable. The physician scheduled the patient for follow-up care for within three to five days. If the follow-up care is for five days or later, the ED coder can reasonably bill for the fracture care with modifier -54, Brame says. [...]
