Orthopedic Coding Alert

Fracture care is one of the most complicated procedures to code. Coders continually question whether they should report a global fracture treatment code or an E/M services and casting code. Further complications arise when one physician performs the initial fracture treatment and another physician assumes responsibility for the follow-up treatment.

Upon closer inspection, a reader question and answer from the April 2001 Orthopedic Coding Alert (Fracture Without Castings, page 32) did not fully address this complex issue. Michelle Logsdon, CPC, CCS-P, billing manager and compliance officer at Ocean Orthopedic Associates in Toms River, N.J., wrote that our response to the question was unclear. The response advised practices to code for the highest reimbursement, depending on how many times the patient will return, Logsdon says. Billing for E/M services because you will get paid higher overall for the amount of visits should not determine how you code.

Logsdon reasons that a nondisplaced fracture, when manipulation is not necessary but casting is, should be billed as a treatment of fracture. As with fractures that do not need casting, we still bill for the treatment of that fracture, she says. I find it easy to explain to my patients that the treatment for the fracture is the doctors decision. If the orthopedic surgeon felt a cast was not needed, as in a nondisplaced metatarsal fracture, and just a firm shoe was required, that is his decision as to the best form of treatment.

The answer to the original question was incorrectly attributed to our consulting editor, Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J. Stout agrees that the original answer was not thorough.

A lot of coders questions about fracture care can be answered by carefully reviewing the instructional notes that appear at the beginning of the musculoskeletal system section (20000-29909) and the application of casts and strapping (29000-29750) section of CPT 2001, Stout says. The instructional notes that precede the codes in the application of casts and strapping section of CPT state, The physician who applies the initial cast, strap or splint and also assumes all of the subsequent fracture, dislocation or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes.

By reporting a global fracture care code, you are billing for a package of services. This package includes the initial treatment of the fracture with or without cast application and all follow-up visits related to treatment of the fracture for a 90-day [...]