Wiki basic coding ?. office visit + fracture care

[jaciwismar]

Can an orthopaedic physician charge for an office visit AND fracture care when seeing a new patient in the office for the first time. Can you please direct me to documentation?
Thanks in advance,
Jaci

 

[cristina1123]

OV and FX care

Yes you can bill for NEW patient with FX care charge
code the E/M level - appending modifier 57
as well as coinside the proper diagnosis with the fracture care.
I work for a major Orthopedic practice, and do this everyday
Hope this helps!

 

[Donna T]

I believe that is incorrect. You can definitely bill for an office visit and fx care on the same vist but a -57modifier is used to indicate the decision for surgery therefore, you should be billing the office visit with a -25 modifier and not a -57 unless the fracture requires a visit to the OR. If that is the case then the -57 modifier would be used.

 

[dclark7]

Actually the 57 modifier is used for any procedure with a 90 day global period. While (non-manipulative) fracture care is technically not surgery it does have a 90 day global so the 57 modifier is appropriate. However, it also depends on how the carrier wants the charge coded, some want 25 and others 57, I've found though that the majority want 57.

 

[mitchellde]

technically anything with a CPT code 10000-69999 is considered a surgical procedure
a minor procedure is anything with 10 days or less in the global and is considered safe for a physician office, a major procedure is aything with more than 10 days in the global and can require the use of an OR.
A 25 is used for an E&M on the same day as a minor procedure, a 57 is used for an E&M when a major procedure is either planned or performed within a reasonable timeframe as the day the decision was made such as same day.