Orthopedic Coding Alert

When patients go on skiing vacations and return with new injuries, both the treating and post-op physicians can collect Whether you're in Florida or Colorado, chances are you're going to have to code for ski injuries this season - and it doesn't have to be an uphill battle. Use this expert strategy for coding your physician's subsequent care of patients who tackled the mountain and lost. Split Care Warrants Modifier -55 Coders in warmer clients are often unfamiliar with reporting skiing injuries ... until a patient goes on vacation and returns in a cast. If you take over the fracture care, you can still recoup reimbursement for your physician's services if you append modifier -55 (Postoperative management only).

Suppose a patient falls while skiing in Colorado. The local orthopedic surgeon sees the patient in the emergency department and diagnoses a closed femoral shaft fracture (821.01, E885.3). He treats the fracture with intramedullary rodding. The patient returns to her home in Florida, where a local orthopedist takes over her follow-up care. The Colorado orthopedic surgeon reports the surgery code (27506, Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws), so where does that leave the home-town orthopedist?
 
The physician in Colorado performed the surgery, so he should report the surgical CPT code with modifier -54 appended, says Mary Ellen Fletcher, CPC, administrative assistant in the reimbursement department at the American College of Emergency Physicians. Modifier -54 (Surgical care only) tells the payer that the Colorado physician performed the surgery only, not the postprocedure care. The Florida physician would report 27506-55 to denote his work performing the postprocedure care during the global period.
 
Scrutinize Op Report for Boot-Top Fracture Boot-top fractures are common skiing injuries, but some coders aren't sure how to report this diagnosis. "A boot-top fracture is any tibia fracture, with or without fibula fracture, that occurs at the top of a ski boot," says Paul K. Kosmatka, MD, orthopedic surgeon at the Marshfield Clinic. You would assign 823.xx (Fracture of tibia and fibula ...) to this injury.
 
"Usual treatment is surgical, either with an intramedullary rod or plate and screws," Kosmatka says. "Occasionally, a nondisplaced boot-top tibia fracture can be treated in a cast."
 
If the surgeon inserts an intramedullary implant, you should report 27759 (Treatment of tibial shaft fracture [with or without fibular fracture] by intramedullary implant, with or without interlocking screws and/or cerclage).
 
If the orthopedist performs a closed tibial shaft repair with manipulation, 27752 (Closed treatment of tibial shaft fracture [with or without fibular fracture]; with manipulation, with or without skeletal traction) is the right code.
 
If the orthopedist subsequently removes the hardware (such as screws and plates), you [...]