Wiki Fracture care complication

[pthurm]

We are an urgent care facility who saw patient initially for fractured ankle w/o manipulation, just casted, etc. (27786 CPT code). Our intent was to treat the fracture here for the global period. However, when pt returned in 6 weeks for followup care and x-ray, x-ray revealed nonhealing, and provider referred this Medicare patient onto ortho surgeon. Does this complication and change in plans for 90 day global care by us, change how I need to bill our services to Medicare using a corrected claim/redetermination to casting code 29515? Thank you for your help!

 

[bfontaine]

It depends...

You will need to check with your Medicare carrier. I am with an Orthopaedic Clinic in Missouri and they have said that if the providers intent is to treat the patient for the whole global, and something happens to disrupt that, it will not change the code that you have already billed. The ortho who takes over care will probably just bill for the non-union and any surgery that may require. He may have to fight to get his money, but he won't have to bill using any modifiers if he isn't part of your tax id. I would definitely check with your Medicare carrier and see what they say. I'm pretty sure if you billed them six weeks ago that you get to keep the money! Good luck!

 

[pthurm]

Thank you very much! I appreciate your input!