Wiki Fracture care - Distal Radius/Ulna

[Jlbirmingham]

A patient with a distal radius fracture along with an ulnar styloid fracture is seen in the office. During the office visit, the patient is casted and makes the decision to proceed with an ORIF of the distal radius fracture. This surgery scheduled on the day of the initial visit and is performed within 2-3 days.

Can the physician bill 25650 (Closed treatment of ulnar styloid fracture) at the initial visit along with the 25607-25609 (ORIF distal radius) with a 58 modifier a couple days later?
Should the initial fracture care actually be 25600 since a cast would treat both fractures?
Should the initial visit only include an office visit & xray with the cast application and materials?

 

[Orthocoderpgu]

If you read the coding instructions in this section it clearly states that the ulnar styloid fracture is bundled with the distal radial fracture. You can bill the distal radial fracture and then the ORIF a few days later with the -58. I would not doubt that the doc wants to "thread the needle" and bill both just to get a few extra bucks, but that is not appropriate and could invite audits as well.

 

[Jlbirmingham]

Thank you for your answer.

That was my thought as well but I am having trouble finding any documentation to say that it cannot be done.

 

[Orthocoderpgu]

Thank you for your answer.

That was my thought as well but I am having trouble finding any documentation to say that it cannot be done.

Ask your provider if they want to INVITE an audit. They do it on one, they will do it on others, next thing you know the insurance company takes notice and they start watching you.

 

[iowagirl77]

According to this article, it may depend on the payer. However, I play it safe and assume everyone goes by Medicare rules on this.

https://www.karenzupko.com/multiple-fractures-one-code-multiple/