Wiki Fracture question??

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Amzie

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:confused:

I am needing some assistance if anyone can help me:

One of my ortho doctors saw a patient in the office for a fracture, he said that the patient was seen in the ER and the ER dr reduced the fracture. Of course we dont know who this was done by, but my dr then had to re reduce the fracture because it still was not aligned properly.
He then tells me that he is also taking the patient to surgery next week for an ORIF, and he wants to bill for the office visit as well as the closed reduction with manipulation? Can he do this?He is taking the patient to surgery for fixation, isn't coding for the manipulation kind of not right since he knows it needs internal fixation??

I agree with my doctor on his point but not sure from a coding stand point? Can anyone help me out on this? Is there any information that I can reference to?

I appreciate all the help!
 
Yes, this is absolutely correct and allowable to bill an E&M service with a modifier 57, and the fracture reduction he performed in the office and then bill for an ORIF with a mod-58 for a staged procedure. As long as all of the required documentation is there to support the codes independently. The ER physician I am assuming is with a different practice and they will typically bill with a mod-54 for surgery only removing the global period.

I now it feels weird, but that's why we have modifiers for us and our providers. Mary LeGrande from Zupko has extensive experience discussing this topic. I like to go to their question and answer forum for these types of scenarios.

I hope this helps.
 
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If the fx was a malunion then should this have been coded as a malunion and the surgery then a correction of the malunion? That is what it looks like from what you stated originally.
 
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