Primary Care Coding Alert

Question: When a patient presents with a fracture, how long after the accident can we bill for the patient's fracture treatment?

Arkansas Subscriber

Answer: CPT does not base its fracture care codes on any length of time, but rather on the condition that the physician treats.

If the family physician treats an acute fracture and provides follow-up care, you should report the appropriate fracture treatment code regardless of whether the fracture is three hours or three weeks old. Some fractures can be difficult to diagnose until a period of time has passed.   

If a physician outside of your practice (such as an orthopedist) renders the patient's initial fracture treatment and your practice merely provides follow-up care, you should report E/M codes for your visits with the patient, along with any casting or cast replacement codes. As an alternative in this situation, some practices choose to append modifier -55 (Postoperative management only) to the appropriate fracture care code.