Primary Care Coding Alert

Question: Our FP saw a patient in the emergency department (ED) and applied a splint. He will be seeing this patient in the office for a follow-up visit to apply a cast. Should I bill the E/M ED care code and the correct fracture care code, or should I bill for fracture care when the patient comes in for the follow-up?

New York Subscriber

Answer: Do not bill for the fracture care at the initial encounter. Bill the appropriate E/M ED code (99281-99285) and the appropriate code for the splint application, such as 29515 (Application of short leg splint [calf to foot]). Because the splint is applied as an initial service without a restorative treatment to stabilize or protect the fracture or to afford comfort to the patient, you may bill the splint application in addition to the ED visit.

You can also add 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 ED code to indicate that it was significant and separately identifiable from the splint application.

Report the appropriate fracture care code at the follow-up when the physician treats the fracture. Do not use a casting code in addition to the fracture care code, because the fracture care codes include the first cast's application and removal.

Sometimes a patient comes to the FP for a follow-up after an ED physician treated her in the ED. As long as the ED doctor billed only for splint or cast application, the FP can then use a fracture care code. But if the ED doctor billed for fracture care, the FP cannot because it is a global service and therefore encompasses follow-up care and cast removal.