Diana2032
Networker
Good afternoon,
My orthopedic surgeon wants to bill for a closed reduction w/o manipulation code (24500) on 6/8 and bill for the ORIF (24515) on 6/9 (the following day). I advised the provider that all he did on 6/8 was assessed the condition and plan for surgery therefore, 24500 is not separately billable. According to the guideline I'm currently reviewing "if plan is for manipulative procedure at a future date, non-manipulative fracture management should not be billed" If however, "treatment is instituted, with the possibility for a manipulative procedure at a future date, bill non-manipulative fracture management". In this case, the provider already knew and planned for surgery the next day.
My understanding is that closed reduction codes without manipulation involve treating a fracture until is healed that's why they carry a 90-day global day.
My provider wants me to add modifier 58 to the ORIF code but I think is inappropriate. I honestly think all he should be billing for 6/8 is the E/M code along with modifier 57 and for 6/9 bill for the ORIF.
Any opinions will be appreciated.
Thank you.
My orthopedic surgeon wants to bill for a closed reduction w/o manipulation code (24500) on 6/8 and bill for the ORIF (24515) on 6/9 (the following day). I advised the provider that all he did on 6/8 was assessed the condition and plan for surgery therefore, 24500 is not separately billable. According to the guideline I'm currently reviewing "if plan is for manipulative procedure at a future date, non-manipulative fracture management should not be billed" If however, "treatment is instituted, with the possibility for a manipulative procedure at a future date, bill non-manipulative fracture management". In this case, the provider already knew and planned for surgery the next day.
My understanding is that closed reduction codes without manipulation involve treating a fracture until is healed that's why they carry a 90-day global day.
My provider wants me to add modifier 58 to the ORIF code but I think is inappropriate. I honestly think all he should be billing for 6/8 is the E/M code along with modifier 57 and for 6/9 bill for the ORIF.
Any opinions will be appreciated.
Thank you.
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