Wiki Fracture Care & E&M

[CBC]

I'd like some advice on billing for an E&M service along with fracture care. When the patient is sent over from urgent care with xrays and the orthopedic performs the following:
HPI - 74yo who fell down a hill 1 1/2 wks ago & sustained rt ankle lat malleoulus fx. Xrays show fx mortese intact. PFSH complete. ROS -0
Exam - Musculoskeletal - ankle skin, pulses, rom, tenderness all mentioned
Constitutional, HEENT, Neck, Lymph
MDM - closed reduction, cast with instructions & return 2 wks

I feel this is all part of the global fracture care and I'm wondering if anyone has advice of when it would be appropriate to pull an E&M out to bill also?

 

[OCD_coder]

Fracture care has a 90 day global typically. The initial E&M service by the provider is not part of the global package per CPT and CMS and is entirely billable. They have to determine what kind of treatment plan is best for the patient, splinting and follow up to the extreme of an ORIF.

Their cognitive process of reviewing the x-rays and discussion with the patient about how to take care of their fracture through possible complications are part of that initial visit. In our caution not to over-bill we don't want to deny our providers due reimbursement for work performed.

 

[CBC]

I appreciate your input!! The vague area for me is what exactly is included in the global period of fracture care. Reveiwing xrays and explanation of care are not considered part of fracture care? I would need to place a 57 on the E&M for decision of surgery for closed treatment of fracture (cast). Thank you for advice!

 

[JillSmithers]

The vague area for me is what exactly is included in the global period of fracture care. Reveiwing xrays and explanation of care are not considered part of fracture care?

I have the same issue. What all is included in fracture care for the global period.