chelsey71
Contributor
We are having a discussion in our office as to just when fracture care begins. The providers are under the assumption that if they apply a splint, they are not assuming fracture care, but once they place a cast, they have assumed fracture care. Even if the splint was applied by the same provider who then casts the patient. We do have some providers who are emergency after hours only, and I can see continuing to bill that way in their cases as they will not be doing the casting, only initial splinting/stabilization, hence they are technically providing the same services as an ER doctor. However, when the patient is seen by a provider who has regular hours, fracture is diagnosed and clearly stated, splint is applied to stabilize injury pending decrease in swelling, and the patient comes back in 3 days, I have been taught that fracture care was assumed on that first visit/splinting due to the fracture diagnosis and stablization being performed. The casting would merely be a staged procedure as not all fractures require casting for treatment.
Am I correct in wanting to bill out the fracture care with the first visit when an xray is reviewed, fracture is clearly stated/diagnosed, and stabilization started? The office has been billing an E&M along with splint application for the first visit and fracture care for the next if a cast is applied. If the patient is only splinted, they are not billing fracture care.
I do realize that there are some simple fractures that it is better to just do the E&M's and splinting with no global billing, but this is specifically relating to fractures with higher RVU's that are not being referred out to an Orthopod.
As this office a pediatric practice, emergency and regular, they do first treatment on many patients. I do realize that this is the orthopod forum, but as I am coming across difficulty in discussing this in our office as they keep stating that ortho has 'different rules' than pediatrics. I was taught that rules are rules are rules.
ANY HELP WOULD BE GREATLY APPRECIATED!!!
Thanks!
Am I correct in wanting to bill out the fracture care with the first visit when an xray is reviewed, fracture is clearly stated/diagnosed, and stabilization started? The office has been billing an E&M along with splint application for the first visit and fracture care for the next if a cast is applied. If the patient is only splinted, they are not billing fracture care.
I do realize that there are some simple fractures that it is better to just do the E&M's and splinting with no global billing, but this is specifically relating to fractures with higher RVU's that are not being referred out to an Orthopod.
As this office a pediatric practice, emergency and regular, they do first treatment on many patients. I do realize that this is the orthopod forum, but as I am coming across difficulty in discussing this in our office as they keep stating that ortho has 'different rules' than pediatrics. I was taught that rules are rules are rules.
ANY HELP WOULD BE GREATLY APPRECIATED!!!
Thanks!