Wiki Fracture Care Globals in Pediatric Practice

[chelsey71]

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!

 

[FTessaBartels]

When are you treating the fracture?

I am NOT an Ortho specialist, BUT ...

It seems to me that you will never have just one answer to this. The key question is WHEN are you treating the fracture?

As you've no doubt noted, there are fractures that require only splinting (or even just buddy-taping - e.g. a broken toe). If the splint is the definitive fracture treatment, then code the fracture care and begin your global period. On the other hand, if you are just providing a temporary stablization and comfort before you can adequately evaluate and treat the fracture, code just the E/M & splint application for this first visit.

It is never appropriate to unbundle the service provided into E/Ms and splinting just because you may get paid more that way. (Although I agree that it doesn't make much sense sometimes how little we are paid for a global package on some procedures.)

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[chelsey71]

Main issue..

The main issue we seem to be having on the fracture care global is that we are open 24/7 and have providers who are after hours only or no regularly scheduled hours (coverage for only a few days a month, etc), and the billing of the global due to that circumstance. At that time, I look at it that the provider who falls under that category would only charge the E&M and stabilization, and the provider who sees them next and casts would provide the fracture care (with receipt radiological documentation of a fracture). Though as the practice is large and patients don't always schedule their follow up at the time they are seen with the same provider who just did the fracture care, how do we not create an issue with the other providers who may end up seeing the patient? If one provider does the fracture care and the patient does not return to them but comes back for the rest of the global time to see providers B, C, and D for once each, with the providers paid by RVU's, it's a bit of a quandry to bill the global care fairly.
Does anyone have any rationales to help with this???