Wiki Fracture care in office followed by surgery

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amartinez1

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I need help please. We had patient come into the office for a distal radius fracture and the physician perfomed manipulation to align the fracture and then casted the wrist. An xray was performed to see if the manipulation and the cast is in acceptable position. Unfortunatly it did not hold it together and the patient was then indicated for closed reduction with application of external fixator to be performed the next day.

My question is: The doctor wants to bill for the closed reduction done in the office but my understanding is that if surgery is to follow then only the office visit with the application of the cast can be billed and then the closed reduction with external fixator can be billed for the surgery done the next day. Can someone clear my confusion please.

Also i wanted to know if the cpt be billed for the surgery would be 25605 and 20690 or would it be only 25606. I am confused about the percutaneous skeletal fixation. Op report stated the fracture was reduced with destraction and manipulation but was unstable and he proceeded with exteranl fixation. 2 pins were drilled through the 2nd metacarpal and 2 pins at the distal radius, and the pins were then fitted with an external fixator and wrist was distracted to allow reduction of the comminuted distal radus.
 
I've worked in ortho for 5 years. Here's what I know...any time a fracture is manipulated (reduced) it is required that the global fracture care code be billed. Had the doc not attempted reduction you would bill out an E/M possibly with a 57 modifier.

Hope that helps.
 
Since the fx did not reduce correctly the reduction was unsuccessful. I would bill for the office visit, cast and supplies. As for the surgery bill the closed reduction code with the ex fix-both codes are justified. Now in the event the reduction was successful and say 1 week later it displaced you would then bill the closed reduction in the office and add the appropriate modifier to the surgery. :)
 
As for the surgery part I'm assuming this was basically a repeat of the manipulation which ended up requiring an external fixator code 25606-78
 
I would not code fracture care the first time. Decision was made to fix it with surgery. So bill E/M with 57 modif + cast application + cast supplies. And then for surgery bill CPT 25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation. No need for modifier 78 since there is no post op period if you bill it the way i explaind.
 
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