Orthopedic Coding Alert

Consider debridement a separate procedure from 26500 only when gross contamination requires prolonged cleansing. Documentation must support that an appreciable amount of devitalized or contaminated tissue had to be removed or carried out separately without primary closure. Report debridement for these conditions with CPT code 11040 (Debridement; skin, partial thickness) and CPT code 11044 (Debridement; skin, full thickness).

If the fracture is open, it may be necessary to clean and prepare the fracture site prior to any restorative treatment and/or stabilization of the bone. The wound site may be contaminated with foreign material such as glass, dirt, grass, metal, gravel, etc. Open fracture debridement is separately reported under these circumstances and reported with CPT code 11010 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocations[s]; skin and subcutaneous tissues) and CPT code 11012 (... skin and subcutaneous tissues, muscle fascia, muscle, and bone).

Questions Determine Fracture Care Intent:

Fracture care intent is the next step to determine your code choice. Are you going to code "global" or "itemized"? Physicians are given both options.

Here are some key questions to ask:

Global reporting will include the initial cast application and all professional services for a 90-day period. Your physician should not report further reassessment separately. You may report items separately such as: further castings, splinting, radiographs, and supplies. These items are not included in the global period.

Itemized reporting utilizes the evaluation and management code section rather than a surgical fracture care code .In addition, the initial cast application and/or splinting is also reported with the evaluation and management code.

Many times the fracture's type and severity also determines this. For example, if a patient suffers a scaphoid fracture (814.01 or 814.11), they may exceed more than the allowed two follow-up visits within the 90-day global period. Therefore, E/M coding (CPT code range 99212-99215, Office or Other Outpatient Services) would be more advantageous.

But, if the patient has a simple fracture of the distal phalanx (816.02), they may return only one time-- in this circumstance the surgical fracture code (CPT code 26750) is better.

Documentation should also reflect the type of care and treatment. Key items in the initial assessment should have neurologic and vascular status clinically assessed and documented. Documentation should also note the realignment of the broken limb segment and/or assessment of the broken segment. Ask yourself, what type of immobilizing was performed on the fracture? Splinting is critical in providing symptomatic relief for the patient. It also prevents potential neurologic, vascular injury, and further injury to the local soft tissues.

Additional Info

When reporting the global method of fracture care, an E/M service may also be reported. Documentation must support a decision for surgery (modifier 57) and/or a separate identifiable service (modifier 25, Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

With either method, do not forget to report additional supplies of casting materials. CMS has approximately 50 "Q" HCPCS codes that address supply issues with casting/splinting applications. The HCPCS level-II manual offers "A" codes. CPT contains CPT code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided).