Wiki Fx Splint Change

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adunlap23

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I want to check my understanding of billing for fx care...

A fracture patient was placed in a splint in the ED department, and referred to orthopedic care. The ortho physician evaluates the patient with x-rays and appropriate MDM. He and the patient decide on surgery. In the meantime, the physician replaces the original splint.

In this scenario, the physician would only bill for the e/m service, and not closed fx care without manipulation because he did not supply the initial splint...correct?
 
Kind of. The reason the provider would not bill closed treatment is because he is taking the patient for surgery. The closed treatment/splint in that case would not be the definitive treatment of the fracture if they are going in for ORIF. Especially if it did not require manipulation. Think of it more in terms of is it the definitive or final restorative care or do they have to take them for surgery for that?

This was a slightly different question but has links to resources by me: https://www.aapc.com/discuss/threads/fracture-care.199752/?view=date#post-548528
There are links to ACEP, Zupko, and NAMAS as well as the NCCI manual in that thread.
See here too: https://www.aapc.com/discuss/threads/fracture-care-billing-guidelines.194515/?view=date#post-533098

In your example, even if the patient came to your provider (not ED) and they splinted it at the first encounter, since they were taking the patient for surgery, I still wouldn't have coded closed treatment without manipulation I would code the E/M. If they had closed reduced (manipulated) it, then I may have. In your example above the ortho provider would get the E/M with splinting/supplies for the office visit (and maybe XR depending on if they own equipment, done in house, etc.). Then, they would do the global for the ORIF at the time of sx.
 
amyjph said:
Kind of. The reason the provider would not bill closed treatment is because he is taking the patient for surgery. The closed treatment/splint in that case would not be the definitive treatment of the fracture if they are going in for ORIF. Especially if it did not require manipulation. Think of it more in terms of is it the definitive or final restorative care or do they have to take them for surgery for that?

This was a slightly different question but has links to resources by me: https://www.aapc.com/discuss/threads/fracture-care.199752/?view=date#post-548528
There are links to ACEP, Zupko, and NAMAS as well as the NCCI manual in that thread.
See here too: https://www.aapc.com/discuss/threads/fracture-care-billing-guidelines.194515/?view=date#post-533098

In your example, even if the patient came to your provider (not ED) and they splinted it at the first encounter, since they were taking the patient for surgery, I still wouldn't have coded closed treatment without manipulation I would code the E/M. If they had closed reduced (manipulated) it, then I may have. In your example above the ortho provider would get the E/M with splinting/supplies for the office visit (and maybe XR depending on if they own equipment, done in house, etc.). Then, they would do the global for the ORIF at the time of sx.
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Thank you. Your explanation and links were very helpful.
 
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