Pediatric Coding Alert

Deciding whether to code for fracture care or an application can be frustrating enough. But remembering when to report additional services can elude the most experienced pediatric coder.

When a pediatrician treats a fracture, you have two code choices, says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric & Adolescent Medicine PA in Medford, N.J. You may either report the complete care using the global fracture code or bill for each service and procedure. "I usually bill for the global code, which pays a little better than itemizing the visits," he says.

For instance, when Scott treats a clavicle fracture, he bills the global fracture code 23500 (Closed treatment of clavicular fracture; without manipulation). The fracture treatment includes 90 days of postoperative care. During that time, Scott does not separately bill for related visits to re-evaluate the fracture.

Whether you report the global fracture care or each visit's services, you should also report supplies used, Scott says. For the supplies, you should ideally assign the alphanumeric HCPCS level II supply codes, such as L3660 (Shoulder orthosis, figure-of-eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment) for the clavicle strap. For payers that do not accept HCPCS level-two supply codes, use 99070 (Supplies or materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). Because 99070 is a general code that does not specify the supply, some insurers do not recognize it. Plus, if the pediatrician performs in-office x-rays, don't forget to report the appropriate codes using the radiology series for x-rays (70010-76499).

Some E/M services may also apply. For a significant, separately identifiable E/M service, append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, such as 99202-99203 (Office or other outpatient visit for the evaluation and management of a new patient ...) for new patients or 99212-99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) for established patients. Also, you may use the global follow-up 99024 (Postoperative follow-up visit, included in global service) when the pediatrician replaces a cast or provides follow-up care.

Marie Felger, CPC, an American Academy of Professional Coders-certified coding instructor with Joy Newby & Associates LLC in Indianapolis, suggests that pediatrician coders adhere to the following guidelines: