Wiki Can you bill e/m with fracture care for first visit to Ortho?

Create Wiki
S

smh

Contributor
Messages
14
Location
Byron Center, MI
Best answers
0
Patient was seen in ER and splint was applied. Next day the patient came to the Ortho office as a new patient where a new splint was applied, xrays reviewed, care instructions given and follow up apt made. Doctor billed 26600 fracture care code, can we bill for an e/m with 57 as well since patient was new and decision for fracture care was made at that time? And if there's any credible sources/articles I can reference? Thank you in advance!
 
Reality might get you on this...

It's very probable that the ER doc is billing the fracture care code. If true, your doc could be out of luck.

I get this all the time.
 
Last edited:
In most cases the ER does not bill the fracture care code as they are referring the patient to an orthopedic for follow up.

I worked in an Ortho office and we ALWAYS billed a new patient visit with a 57 modifier and the fracture care code. We never ran into a denial off of the ER charges. Patients typically come from the ER with a splint or soft cast and the ortho may then apply a hard cast. The initial cast is included in the fracture care code. However if you re-apply a cast during that 90 day global period you are allowed to bill for subsequent casting and supplies (58 modifier on the cast application).
 
We always billed an e/m for the initial visit along with fx care code. I never ran into an issue with the ER doc billing fx care.
 
You must log in or register to reply here.
Top