Wiki 2022 cpt fracture tx update

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tamale79

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Hello,

We've been going back and forth on whether treatment with dme only counts as "closed" per the guidelines update and would therefore put the pt into a global.

"Closed treatment: The treatment site is not surgically opened (i.e., not exposed to the external environment nor directly visualized). Closed treatment of a fracture/dislocation may be performed without manipulation (e.g., application of cast, splint, or strapping), with manipulation, with skeletal traction, and/or with skin traction."

So if a pt has an ankle fx, and the dr puts them into a camwalker, do we charge the fx tx code?? Does a camwalker (or wrist brace, etc) count as a pre-fab splint?

Any help is greatly appreciated, and if you have specific documentation that answers this question, you'll be my new bff!

Thanks
 
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No. What it means is that if the provider charges the closed treatment of a fracture CPT (either with or without manipulation) they can't charge for the casts, splints, or strapping. Just because they are applying a boot for example, you don't automatically code the closed treatment CPT (2XXXX). The provider must document and choose to charge/bill it that way. It's also a question of who is providing follow up care after the closed treatment CPT is billed.

Providers have two options with non-operative fractures. The "itemized" route meaning they bill the E&M and associated services (casting, supplies, etc.) or the 'global" route meaning they charge the "closed treatment" (2xxxx) route (which includes the casting, supplies, etc.) and puts the patient into a global (with some exceptions for codes with 0 global days).

3. Casting/splinting/strapping shall not be reported separately if a service from the Musculoskeletal System section of CPT (20100-28899 and 29800-29999) is also performed for the same anatomic area.
6. CPT codes for closed, percutaneous, or open treatment of fractures or dislocations include the application of casts, splints, or strapping. CPT codes for casting/splinting/strapping shall not be reported separately

These may have older dates but the concept is the same:
 
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So it's just like it has always been! Thanks for the info. This all started b/c I took a webinar from the APMA, and they said it is NOT optional anymore.
 
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