Orthopedic Coding Alert

Question: My surgeon would like to charge for closed treatment (fracture care, no manipulation) once he's sure the patient won't require surgery. For example, if at the third appointment, x-rays and examination show that the fracture is stable, may I charge for closed treatment at that time?

Louisiana Subscriber

Answer: You should not report the fracture care this way. Instead, if the surgeon provides closed fracture care at the first appointment, you should report the code then.

If the patient requires surgery later, you would report the appropriate surgical code appended with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period).

If the surgeon doesn't provide closed fracture treatment at the first appointment, you should report the appropriate E/M code with the fracture diagnosis.

Example: A patient with a Colles distal radial fracture presents to the office, and the surgeon performs a closed treatment without manipulation. You should report 25600 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation).

After several visits, the surgeon decides the patient requires percutaneous fixation. For this procedure, you should report 25606-58 (Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation).