ED Coding and Reimbursement Alert

Prepare on-target claims by having all the right info

Don't send your fracture treatment claims amiss because you didn't have the terminology down-pat. Check out these tips to avoid common mishaps.

 - The type of fracture does not always correlate with the type of treatment. The patient can have any combination of open or closed fractures that require open or closed treatment--whether the fracture type is open or closed shouldn't affect your CPT coding. The type of treatment is what determines the CPT code, while the type of fracture determines the ICD-9 code.

 - You need as much detail as possible about the anatomic site of the fracture or dislocation. For example, the specificity of some fracture treatment codes may require you to know which phalanx in a finger or toe was fractured--middle, proximal or distal. Sometimes you may even need to go a step further, and know whether the distal end, shaft, or proximal end of a particular phalanx was injured.

 - If the physician applies a cast or strap, find out the entire scope of treatment. Physicians often fail to give coders enough details about why they apply casts or straps. If the doctor applies a cast or strap and is not performing any type of definitive or restorative care, you can assign codes from the 29000 series (Application of casts and strapping). In this case, the physician is performing the treatment solely to protect the fracture and to afford pain relief, but isn't providing restorative or definitive fracture care.

This is particularly true if an orthopedist will ultimately provide definitive treatment with a more permanent cast or an operative procedure.

Coding tips provided by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems, an ED billing company in Stoneham, Mass.