Orthopedic Coding Alert

Question: Is it legal to charge office visits rather than a global fracture charge for simple fractures? For example, a simple fracture of the distal radius, closed, requiring no reduction, just a cast application.

Beth Osborne
Panama City, Fla.

Answer: The instructional notes that precede the codes in the application of casts and strapping subsection of CPT state, A physician who applies the initial case, strap or splint and also
assumes all of the subsequent fracture, dislocation or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes. By reporting a global fracture care code, 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. With this in mind, in the scenario you describe, it really is not appropriate for your physician to report a code for an office encounter and a cast application.

The source for reader questions is Heidi Stout, CPC, coding and reimbursement specialist at University Orthopaedic Associates, a multispecialty orthopedic practice in New Brunswick, N.J.