Orthopedic Coding Alert

Question: I am writing to ask questions about commonly encountered problems in my practice.

1. The first question involves the patient who has a closed reduction and external fixator application for displaced Colles' fracture done in the operating room (OR) with general or regional anesthesia. If the patient is taken back to the operating room four or six weeks postoperatively for external fixator removal with IV conscious sedation, is the second surgical procedure a billable event?

2. Regarding a patient who is seen either in the hospital or office with a non-displaced fracture, how is the initial encounter billed? Is the initial encounter included in the code for the non-displaced fracture?

P. Jeffrey Jarrett, MD
Fellow, American Academy of Orthopedic Surgeons
Houston Orthopedic Surgery and Sports Medicine, P.D.
Warner Robins, Ga.

Answer: 1. If a physician placed the external fixation, he or she is expected to remove it at no extra charge. It's all part of the global. That includes the sedation for improving the comfort of the patient. (The only exception to the removal being part of the global is if the removal is for a fixation that was supposed to stay in place, a head plate for example, if a screw became loose and a removal was necessary. In that instance it would be billable.)

2. Billing for evaluation and management (E/M) in addition to the code for the non-displaced fracture is carrier specific. In some cases you can bill the E/M but many carriers consider it bundled. You should check with the specific carrier to find out their policy on this matter.

Source for answers: Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C.