Orthopedic Coding Alert

Question: Our orthopedic surgeon was called to the emergency room to treat a patient. After examination and x-rays, the orthopedist diagnosed nondisplaced fractures at the base of the second and third metatarsals. The orthopedist consulted physical therapy for crutch and gait training, gave the patient a cast shoe and scheduled a follow-up appointment at our office. Is it correct to code for a consultation and for care of a metatarsal fracture?

Nevada Subscriber  
Answer: Report an E/M code and a procedure code in this situation. Remember that the global fracture treatment codes were placed in the Surgery section of CPT 2002 for a reason and should be viewed in the same manner as any other code in this section. If your physician met all the requirements for reporting an E/M service (taking a history from the patient, performing a physical examination and deciding on a course of treatment) and will be assuming responsibility for all follow-up care related to the fracture (the global package), he or she can report the E/M code with modifier -57 (Decision for surgery) appended and 28470 (Closed treatment of metatarsal fracture; without manipulation, each) for each fractured metatarsal treated. Many insurance carriers may balk at paying for both services, but this method constitutes accurate reporting of the services rendered.