Wiki Fracture Care Dr. question

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lodawnyoung

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My doctor saw a patient who broke his finger and had it treated in ER with a splint and stiches.

He was seen in our office 5 days later, and my doc removed the splint to examine the finger ie; color, temp, pulse ect. then re-applied the splint.

My doc wants to know if he can charge a fracture care along with the office visit. I say no, but he wants to know why. My thought is because he didn't diagnose the fracture, and there was no medical decision making that went into it from him.

What are your thoughts? Anything in writing would be greatly appreciated.
Thanks,
 
FX

We see patients from the ER all the time that have fractures that the ER will splint and tell patient to follow up with us. We bill for fracture and get the 90 day global to take care of that patient. The ER does not bill for the fracture they bill for the E/M code and the splinting
 
We do the same as Brogdonlawn. Our doctors ordinarily bill the fracture code that has a 90 day global. occasionally they bill an E&M with application of splint/cast if the patient is going to need minimal follow up.
 
So even though our doctor only re applied the same splint. It is ok to charge the fracture care because he is taking over the care for that fracture? Is that right?
 
I say no because this fracture has already been primarily treated, AHA coding clinic 3rd q 2002 states that initial evaluation AND TREATMENT, this is no longer an acute fracture, this is a follow up for a healing fracture and is coded with the V54 code for the dx and an office visit.
For ICD 10-CM this will be coded as a subsequent visit for an acute fx which is the fx code with a 7th character to indicate subsequent encounter, D,E,F,G,H,J,K,M, or N.
 
I am interpreting this encounter with your doctor to be the initial visit for him and he is an orthopedist. Depending on the documentation and the work he performed beyond just removing the splint would determine whether a separate E&M would be billable from fracture care. Based on the limited information you gave here, it may be that only either the E&M or the fracture care is billable.

I agree that typically ER doctors do not bill non-surgical fracture care as they are just stabilizing a fracture until they can be seen by a specialist.Fracture care should be defined as who is actually performing restorative care which is the full course to getting that patient healed. The ER doc will not perform restorative care typically, but stabilize with a splint give initial pain control.

The orthopedist needs to perform medical decision making of some sort to determine if the fracture is severe enough to require ORIF at the initial visit regardless of whether a confirmed diagnosis was determined in the ER. If new X-rays were performed and not just "reviewed" from the ER, it may indicate that both the E&M and fracture care have the documentation to support both.
 
Abby F CPC

Our PA assisted our surgeon on a chondroplasty (29877). Our state Medicaid system has denied the PA as not payable. I can't find anything that says one way or another. I need help!!
 
OCD_coder said:
I am interpreting this encounter with your doctor to be the initial visit for him and he is an orthopedist. Depending on the documentation and the work he performed beyond just removing the splint would determine whether a separate E&M would be billable from fracture care. Based on the limited information you gave here, it may be that only either the E&M or the fracture care is billable.

I agree that typically ER doctors do not bill non-surgical fracture care as they are just stabilizing a fracture until they can be seen by a specialist.Fracture care should be defined as who is actually performing restorative care which is the full course to getting that patient healed. The ER doc will not perform restorative care typically, but stabilize with a splint give initial pain control.

The orthopedist needs to perform medical decision making of some sort to determine if the fracture is severe enough to require ORIF at the initial visit regardless of whether a confirmed diagnosis was determined in the ER. If new X-rays were performed and not just "reviewed" from the ER, it may indicate that both the E&M and fracture care have the documentation to support both.
Click to expand...
It is not that this is an initial visit for the provider but is it initial for the patient. If the ER had not treated the fx with the splint then the injury would not have had initial treatment and it would be initial for the ortho. But since a splint was applied as definitive treatment then the patient is only seeing the ortho for follow up care. The dx is there for the patient not the provider.
 
My edits indicate it is allowed, but that's AMA and CMS. Unfortunately, I think you're going to have to work directly with your Medicaid system to see why they won't pay it. Good luck!

And I'm not sure what the 29877 bundling response was about.
 
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