Pediatric Coding Alert

Report separate E/M services with modifier -25 when using global fracture-care code When the pediatrician treats a fracture in the office, you can either report a global fracture-care code or report each service separately; the choice you make depends on the extent of the physician's services, coding experts say. Fracture Approaches Vary by Practice While most fractures are referred to an orthopedist, some pediatricians treat certain fractures in their offices. Just what each pediatrics office treats is entirely up to the physicians and staff.

"Our pediatricians will treat clavicle, finger and toe fractures" because they're usually pretty basic procedures, says Victoria S. Jackson, administrator at Southern Orange County Pediatric Association in Lake Forest, Calif.

"I've heard everything from 'It's not appropriate for us to code for fracture care' to 'We only code for fracture care if there's manipulation' to 'We code for everything' " when a patient reports to the pediatrician's office with a minor fracture, says Karen Marsh, RN, MSN, president of Kare-Med Consulting in Jensen Beach, Fla. What Are My Options? We will examine how to report a global fracture-care code and how to report each service separately using the scenario below.

Scenario: A 5-year-old established patient reports to the office without an appointment with pain, swelling and tenderness of the left wrist and forearm after falling off a seesaw. The pediatrician takes two x-rays of the forearm and finds a buckle fracture of the wrist, which he stabilizes with a splint before sending the child home.
 
Option 1: Report Fracture-Care Code The easiest way to report the child's visit is to use one of the fracture-care codes. In this case, report 25600 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation). If the pediatrician performed the x-rays (as he did in the above example), report CPT 73090 (Radiologic examination; forearm, twi views.). X-rays determine the patient's condition and the course of care, so they are never included in global packages. You can also report any follow-up X-rays separately.

The global period for 25600 (Closed treatment of distal radial fracture ...) is 90 days and encompasses any immediate care related to the fracture, including dictating procedural notes, counseling the family, and speaking with other physicians about the patient, according to CPT 2004.

Warning: Code 25600 bundles in supplies and any follow-up care related to the procedure.
 
"If you do code for fracture care, that includes casting and splinting as well, so you cannot report those separately," Marsh says.

Use Modifier -25 for Separate E/M During initial fracture treatment, report a separate E/M service when the doctor checks for some other trauma. In the previous example, if the pediatrician [...]