I've come to a disagreement with one of my physicians who performs surgery for pelvic fractures on the appropriate billing of an E/M code with 27197 [closed treatment w/o manipulation of a posterior pelvic ring fracture/dislocation/etc., with or without anterior pelvic ring fracture(s)/dislocation] due to 27197 having a Zero-day global with CMS. In my experience and research with these scenarios, the fracture is evaluated and the "fracture care" is generally weight-bearing restrictions, crutches, and bed rest which is essentially the "Plan" section for the consult. In this situation, where only pelvic ring fractures are being evaluated, I haven't found ample evidence to bill a separate E/M code with modifier 25. However, if there was a separate injury or condition that was also being evaluated, I would feel comfortable billing a consult with 27197.
Am I being too strict in my criteria for a significantly separate evaluation and management in this circumstance? I generally use the CMS guidance that states an evaluation resulting in the decision for major surgery can be separately reported to support global fracture care codes, but 27197 is, for the most part, considered a minor procedure. I'm interested to hear how others have been tackling this.
Am I being too strict in my criteria for a significantly separate evaluation and management in this circumstance? I generally use the CMS guidance that states an evaluation resulting in the decision for major surgery can be separately reported to support global fracture care codes, but 27197 is, for the most part, considered a minor procedure. I'm interested to hear how others have been tackling this.