Wiki Fx care coding-documentation

[apollo06]

I have a sports med provider who uses fx care codes (i.e 22310)when treating spondylolisis (his mdm consists of a TSLO brace and rest). His documentation states fx. Diagnostic test confirms spondyloisis but doesnt say fracture. It seems his claims for that particular CPT are getting paid. Different doc same practice, treating same types of condition but DOESNT use fracture in his documentation and his fx care codes are NOT getting paid. His mdm is the exact same type of plan of treatment. So my question is, does the documenation of fracture in the patients record make a difference? I hope this isnt to confusing. Thank you for any help

 

[mitchellde]

perhaps it is the dx code? if one uses a dx code of fx and the other does not. if the test says no fx then you cannot code it and I do not think fx care is the appropriate treatment code. I would need all the documentation to advise further. But medical necessity for payment would be triggered by the dx codes used.

 

[apollo06]

that is what Im thinking, as the one provider is using stress fx as his primary dx and spondylolisis as his secondary. The provider who is NOT getting paid is using spondylolisis as primary and low back pain as his secondary. thank you