Primary Care Coding Alert

Don't lose out on entitled revenue when your family physician (FP) treats fractures or replaces a cast. This handy chart will eliminate confusion over choosing a fracture or a cast and strapping code, and a quick glance will tell you whether to bill for an E/M service, x-rays and/or supplies.

To determine the appropriate combination of codes, consider the FP's role in caring for the injury. "During any encounter, if the FP performs in-office x-rays, you should report the appropriate codes using the radiology code(s) for x-rays," says Beth Glenn, CPC, CMA, certified coder for Jefferson Family Physicians in Jefferson City, Tenn. In addition, report any supplies with a HCPCS level-two supply code. For payers that do not accept HCPCS codes, use 99070 (Supplies and 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]). For a significant, separately identifiable E/M service, append modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code, such as 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient ). Also, you may use the global follow-up 99024 (Postoperative follow-up visit, included in global service) when the FP replaces a cast or provides follow-up care.

Both Glenn and Marie Felger, CPC, a family practice coding consultant and American Academy of Professional Coders-certified coding instructor with Joy Newby & Associates LLC in Indianapolis, suggest that FP coders adhere to the above guidelines: