Wiki Fracture Care in the ER-Need some help...

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agontz

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Need some help.....If a patient comes to the ER, sees an ER physician for a fracture and then get refered to our ortho dept for follow up..who bills what?
The ER doc is billing for fracture care and then our ortho docs get stuck with the follow up care (which they can't bill for due to the 90 post-op). Ortho wants the ER to bill the ER E&M and let them bill for the fracture care because the ER doc is not doing any follow-up..is that correct? Or can the ER bill for the fracture care but needs to add a modifier? and if they can bill that what does ortho then bill??
 
What we do might not necessarily work for everyone. We are a hospital based orthopedic provider. Typically, when a patient is seen in the ED, the ED provider will charge their E&M service along with application of splint. They set up an appt with one of our docs, who charges the fracture care. It would seem logical to me that if the ED provider would want to charge the fracture care, they could do so and add modifier 54 (surgical care only). The provider who is assuming the follow up care could charge the fracture care and add modifier 55 (post-operative management only). I wonder what other providers are doing in this instance?
 
The ER doc can bill for fracture care. He needs to apply a -54 modifier on the procedure code which states surgical care only. The ortho doc can then bill the same procedure code with the modifier -55 which states postoperative management. The ER doc should only be charging for fracture care if the patient is to follow-up with ortho in a week or so. If the follow-up time is within a few days then the ER doc should only be charging the splint.


agontz said:
Need some help.....If a patient comes to the ER, sees an ER physician for a fracture and then get refered to our ortho dept for follow up..who bills what?
The ER doc is billing for fracture care and then our ortho docs get stuck with the follow up care (which they can't bill for due to the 90 post-op). Ortho wants the ER to bill the ER E&M and let them bill for the fracture care because the ER doc is not doing any follow-up..is that correct? Or can the ER bill for the fracture care but needs to add a modifier? and if they can bill that what does ortho then bill??
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One thing the ED might consider is the ED E/M code mod-25, cast application and supplies. Then let the ortho code the fracture care since they will be taking care of the patient from then on. Unless the ED is actually doing manipulation, then they should code fracture care with -54.
 
We are also hospital based ortho and I code for the ED. I wouldn't allow my ED Docs to code fracture care unless they did a closed reduction for example. Then I would code the fracture care with a mod-54 and the ortho could code the follow up care with a mod-55. Otherwise the ED should only code the appropriate E/M along with casting/splinting and ortho should code the fracture care. Typically we do not run into this scenario. Usually when any reduction or manipulation is required in the ED an Ortho specialist is called in.
 
I agree with Treetoad - ER doc should code E/M - ortho should be coding Fracture TX as they will also be doing the followup. It's my understanding that the only time and ER/ED codes for a fracture care is if they "actually" perform the fracture, (eg, casting, manipulation - open, closed) but if they just make the patient "comfy" and send them on to ortho, it should be an E/M charge for the ER/ED.
 
what we do is if the fx required a manipulation or reduction by the ERP then we bill the fx care code with a 54 modifier along with our E&M ER code. But if there was no manipulation/reduction and pt is being referred to Ortho, we only bill our ER E&M and let Ortho have the fracture care code......
 
So, the ER Dr. attempts a closed treatment of shoulder dislocation, with fracture, with manipulation - unsuccessfully, at the request of the ortho Dr. we are referring to. We are transferring to ortho at another facility. Would the ER Dr. code the fracture care with modifier 53 and 54 for the attempt? The receiving Dr. would then use same code with modifier 55?
I've confused myself badly. Please help.
 
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