Wiki Can you code for fx care if the decision for surgery is made?

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flogale2

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Help I am so confused.


If a patient comes in with a fracture and the decision is made that day that they need to have an ORIF do you code the fracture care code and the code for the ORIF? Or do you just code for the ORIF?

Now my other question is if the patient comes in the decision is made for an ORIF but the procedure is done two days later after the intial visit. Do you code for the fracture care on the initial visit. Then on the ORIF two days later code for the ORIF with a modifier?

In the practice I work for I come across many patients that are seen inpt for a fracture and the decision is made for them to have an ORIF or hemiarthoplasty the next day or same day. Lately I am also seeing patients coming into the office and told they need to have an ORIF and it is done two days later. I just want to clarify.


Hoping someone can help me.
 
Fracture care vs ORIF

When a patient is initially seen for a fracture, the treatment will either be:
* Fracture care without manipulation
* Fracture care with manipulation
*ORIF

Keep in mind that all fracture care codes have a 90 day global.

If the fracture does not need ORIF, then fracture care would be billed.

If under fracture care the bones displace and the decision to perform ORIF is made, then you would bill for ORIF at that point. That's really the only time that you would bill fracture care and then ORIF is if the bone(s) displace.

Prior to ORIF you can bill whatever E/M is appropriate for the patient: Inpatient, ER or whatever.
 
Just wanted to add:

CPT casting/strapping code series 29000-29799 is the same for both physician and outpatient hospital reporting.

Casting/strapping code series 29000-29799 are USED to report:
* A replacement cast/strapping procedure during or after the period of normal follow-up care.
* An initial service performed without restorative treatment or procedures to stabilize or protect a fracture, injury or dislocation, and/or to afford pain relief to a patient.
* An initial cast/strapping service when no other treatment or procedure (specific to that injury) is performed or expected to be performed by the same physician (e.g. when placed by the ED physician).

Casting/strapping code series 29000-29799 are NOT USED to report:
* An initial cast/strapping service when the restorative treatment is performed (e.g. surgical repair, closed or open reduction of a fracture or joint dislocation).
* The application of an air splint is not a separately reportable service. The work of performing a strapping technique is very different than applying an off the shelf item such as a knee or shoulder immobilizer or air splint. The supply of the air splint may be reported with CPT code 99070, supplies and materials, or the appropriate HCPCS level II code.
*Taping techniques (e.g., Kinesio, McConnell) facilitate movement by providing support. The technique restricts in some movement of a body area (e.g. shoulder) but facilitates greater function, such as, range of motion and strength. This type of application is typically part of neuromuscular re-education (97112) or exercise (97110) and 'not' considered strapping unless the purpose is to immobilize the joint.

Also, the guidelines for application of casts and strapping might help you out. These can be found in the CPT book right before CPT 29000.
 
Thank you very much!!! This was the way I had been coding but my office was questioning this and I started to get confused.

Very good information.
 
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