Pediatric Coding Alert

Question: After fracturing a wrist, a patient returns for a follow-up visit in 10 days. On the initial visit, I billed the global fracture code. I do a problem-focused history and physical examination, and low-complexity medical decision-making, followed by an x-ray that shows good alignment and healing. The patient is sent home with instruction about home care and a return visit in one month. Should I code the subsequent visit with 99213 plus the x-ray?


Michigan Subscriber

Answer: No. You should not report the visit with 99213 (Office or other outpatient visit for the evaluation and management of an established patient). Because you billed the global fracture code, such as 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), at the initial visit, the related E/M service for follow-up care is included in the global code's 90-day surgical package.

Code the follow-up visit during the global period with 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure) and a $0 charge.

Don't overlook: The x-ray is not considered part of the package, so you should bill that separately with the appropriate x-ray code (73100-73110, Radiologic examination, wrist ...).

Answers to You Be the Coder and Reader Questions reviewed by Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator.