Podiatry Coding & Billing Alert

Question: A patient was treated for a fracture of the second metatarsal. Four weeks later, an X-ray revealed that the fracture had failed to heal at all. How should I code for the condition of non-healing metatarsal?

California Subscriber

Answer: A delayed union is the failure of a bone to heal. For the first visit, use 825.25 (Fracture of other tarsal and metatarsal bones, closed; metatarsal bone[s]) and 28470 (Closed treatment of metatarsal fracture; without manipulation, each). For the second visit, the diagnosis would be 733.82 (Nonunion of fracture) with late-effects code 905.4 (Late effect of fracture of lower extremities) as a secondary diagnosis.

Be aware that if you bill fracture treatment code 28470 to Medicare, you have put the doctor into a 90-day global, preventing you from billing any more visits for that time period.

Your other option is to bill the patient's first visit as an office visit, which does not have the global period, and then bill an office visit every time the patient returns for fracture care. The second office visit could be billed as 99213 because the patient's condition is not improving and his treatment needs to be re-evaluated. For example, the podiatrist may consider ordering a bone stimulator.

If you have billed a fracture care code, you may be able to bill the second office visit as E/M code 99213 by including a note that the nonunion is a complication above and beyond normal post-op or global and appending modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M.