Wiki Billing for fracture care

Create Wiki
K

KristinM522

Networker
Messages
47
Best answers
0
I am having a hard time trying to research this question, hoping someone here has some insight!

We have a physician that thinks it is illegal to bill out fracture care and an E&M code on a follow up visit after he sent the patient out for a test to confirm the fracture (i.e. MRI, CT).. In other words, he thinks the correct billing would be an e/m code on visit 1 and then only a fracture care code on visit 2.

Does anyone know if it is illegal to bill an e/m & fracture care code on visit 2? Part of me feels like this falls under "physician preference" and there isn't legality to the issue. But may there is a rule out there by CMS or otherwise that I am just not finding.

Thank you in advance for any guidance!
 
If the provider already evaluated the patient for the injury then sees the patient back for definitive treatment due to x-ray confirmation then I see no reason to charge an e&m. you will not have the criteria met to bill out a separately identifiable E&M in this scenario
 
I hope this helps

Fracture care has a 90 day global period. You only submit the code to insurance once. During that 90 day period you cannot bill out any related E/M visits because it's part of the fracture care. You can bill out X-rays during the global.

You can bill out fracture care and an E/M on the initial visit.

So after you have billed out the fracture care code the only thing you can bill are X-rays, replacement casts and supplies and UNRELATED office visits, if there are any.
 
Thank you for your responses. While I agree with you both and totally understand the guidelines of billing for services after billing for the fracture care. Are either of you aware of any written guidelines that say the MD cannot bill an e/m w/ the fracture care code after said patient is sent for testing and then comes back to review and discuss further treatment (fracture care would not have been billed yet at this point)? This testing would fall along the lines of an MRI or CT scan, we do x-rays at the initial visit so this wouldn't be an issue to confirm on that visit.

Assuming, on the follow up visit, the physician's documentation meets the criteria for an established patient OV.

This physician thinks this is an issue of legality, so we are trying to find out if there are any CMS policies that pinpoint this exactly.

Again, I appreciate your responses!
 
No you cannot bill an E/M code

If I understand your scenario, you are saying that the patient is having a fracture evaluated, sent for MRI on the same day, and then the patient returns the same day with the MRI or CT results, and then the doc does the assessment.

If all of that is done- on the same date- you can bill the E/M and fracture care since it's the initial visit.

Since the "intent" is to get more information and have the patient return, the key components from both visits are added up and one E/M billed with the fracture care code.
 
Last edited:
Orthocoderpgu said:
If I understand your scenario, you are saying that the patient is having a fracture evaluated, sent for MRI on the same day, and then the patient returns the same day with the MRI or CT results, and then the doc does the assessment.

If all of that is done- on the same date- you can bill the E/M and fracture care since it's the initial visit.

Since the "intent" is to get more information and have the patient return, the key components from both visits are added up and one E/M billed with the fracture care code.
Click to expand...

Appreciate your reply, would more then likely be 2 separate visits, 2 separate appointments. Intent still the same, however there is rarely an MRI/CT appt available on the same day as the initial eval. Thanks again!
 
You must log in or register to reply here.
Top