Orthopedic Coding Alert

Question: The orthopedist sees a patient in the emergency department as a consultant for a displaced bimalledial ankle fracture. A history, physical examination and review of x-rays are done. A recommendation is made for surgery. The patient requested that another physician do the surgery. A cast is applied and the patient leaves. Is the surgeon allowed to bill 27808?

Mark Feldman, MD
Lakewood, N.J.

Answer: In the scenario you describe, your physician should not report 27808 (closed treatment of bimalleolar ankle fracture, [including Potts]; without manipulation). By reporting a global fracture care code such as this, 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 period from the time of the initial encounter. Because your physician will not be following the patient, the service he or she is rendering is less than what is required to report 27808. To report the services he or she has provided, report the appropriate level office or other outpatient consultation code (99241-99245, office consultation for a new or established patient ...) with the code from the application of casts and strapping section that describes the type of cast applied.

You also may be able to report a code for the x-rays that your physician read with the -26 modifier (professional component) appended to the code. According to the Health Care Financing Administration (HCFA) guidelines, the physician whose x-ray interpretation determines the course of treatment can bill for the professional component of the x-ray service. But discuss this matter with your physician before you report an x-ray code.

The American Academy of Orthopaedic Surgeons has published a manual, AAOS Guide to CPT Coding, which includes an informative section on surgical and fracture global fees. Reading this may clarify many of your questions about correct coding of fracture treatment. The guide can be obtained by contacting the American Academy of Orthopaedic Surgeons at 800-626-6726 or custserv@aaos.org.