Wiki Closed Fractures

[Mindy Davis]

I'm needing some clarification on when we can bill fracture care. If a patient comes in for wrist fracture and we splint it and tell the patient to follow up with Ortho. Can we still bill the fracture code. I'm having a hard time understanding this. Thanks

 

[Mojo]

Hi,

Fracture care can be confusing. Restorative care (manipulation of bones to restore or improve anatomic position) or definitive care (not temporary but the same care an orthopedist provides) must be provided and documented to assign fracture care. With your scenario, our policy is to code the splint along with an ED visit whenever the patient will be seen by ortho within the next few days. If ortho needs to cast or pin the fracture, definitive care was not provided in the ED.

Per the AAPC ED Practicum, Medicare requires the provider to apply the splint in order to code it. Splints can be off the shelf and do not need to be fiberglass or plaster. It was also noted that most closed fracture care without manipulation coded in the ED involves fingers, toes, clavicle, rib and nose fractures.

 

[jimbo1231]

Fracture Care

I would agree with Mojo, and also agree fracture care is confusing. Some coding entities take a more aggressive approach than others. Sometimes this is based on whether or not a referral is documented in the chart, and how long after the visit the referral is for.
As to splinting, many practices will bill for non Medicare(and any payer that follows Medicare) if the physician documents evaluating and checking the splinting by the non physician provider. And just stating it was checked isn't enough. Comments on positioning of the splint, and manipulation by the physician if necessary should be documented to support splinting on non-Medicare cases.

Jim