Wiki Fracture Care billable w/consult?

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debwoods65

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We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.
 
debwoods65 said:
We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.
Click to expand...

The 57 modifier is put on an E&M code when billed with a procedure code that carries a 90 day global period.
It has nothing to do with going to the OR.
So yes it is right to bill a consult/E&M code with 57 modifier when billing for fracture care done in an office setting.
 
Modifier 57 or 25 for fracture codes.
Instead of reading the descriptor"as decision for surgery", you please read it as"service that resulted in the decision for closed treatment". Now you are very much justified to append 57.

Thanks to Stephanie who gave the web site in her post.
 
fracture care

Tina-

I was unable to access info. Is there somewhere specific on the PA ortho website to click?

thanks!
 
debwoods65 said:
We have a discussion going on in our office as to whether it is right to bill a consult/E&M code along with the fracture care, using a 57 mod, or only the fracture care when there is no actual trip to the OR. I have seen this done and not sure you would do this using a 57 modifier unless you actually went to the OR with the patient. Would love clarification from others as to what you do in your practices.
Click to expand...

If a patient is sent to the ortho with a known fracture, I think only the fracture care should be coded. If it is questionable and the ortho has to do more E/M type work, then you should code the E/M with modifier -57 and also the fracture care. This is just my opinion...and I welcome all feedback!
 
It's my understanding if the ortho physician diagnosis the fx, then he can bill the E/M with a -25 and the fx care. But if the pt is being referred for a known fx then I would bill for the fx care only.
 
my personal rule of thumb is "if it has a 90 day global, use 57 mod; everything else gets a 25 modifier."
 
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