Wiki Fracture treatment vs. splinting

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jccoder

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Patient diagnosed with metacarpal fracture without manipulation, splint was applied. We have always coded the application of the splint only. Attended an audioconference and presenter stated to charge 26600 closed tx w/o manipulation. ED physician will not be doing any f/u tx. How is everyone else coding this scenario? Our encoder does not take us to 26600.
 
The presenter is correct. Anytime there is a fracture treated in the Ed you would use a fracture treament code. Our encoder doesn't take us there neither but to find the CPT we code as if manipulation was done and whatever code comes up we look at the CPT code and use it as guide. In your scenerio if you would code it in the encoder as with manipulation and get 26605. We would then use that as a guide and look up 26605 and there you will see the 26600 CPt which is what we would charge for.
 
We do code this way at our ED; ex. 99284.57, 26600.54 If the Dr would do manipulation then we would use 26605.54, (we do not have an encoder we pick the codes).
In the cases where the patient will be seen by an ortho within 3 days we only code the splint.
 
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I think that's where I got confused. I also listened to a teleconference where they said to code fx care if no other treatment will be done. I see very few times in our ER when the patient is not referred on to ortho for a fracture. Is the 3 day limit one of your own? If there is documentation that Ortho is to see, do you just assume? Confused here. Thanks
 
To begin with never assume anything, if it is not documented it did not happen. The Doc writes how many days in the referal area of his paperwork. Sometimes 0ne day sometimes 5 days I have no idea what drives their decision on the amount of days.
I really think the 3 day rule is specific to each ER, some may code all FX care no matter what and some may not code any at all only splints. That's just the way we do it, we have a 72 hour (3 days) rule and we stick to it. I can't say why or how they came up with that time period; in my own mind I think if the pt does not see an ortho within 72 hrs their FX is not that bad and may heal correctly even if they never go to an ortho. Keep in mind this is ER visits there is no way we can know what they will do once they leave the ER. They may go home and wear the splint we gave them for 6 weeks and call it a fix. (If you notice when the FX is severe they are either admitted or immediately sent somewhere else) But like I said that is only my deduction of the rule. I code for a high volume ER and it works well for us. You want to get the most reimbursement for your Docs that you can, this is business.
 
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