I am wanting to find the specific guidelines on billing initial global fracture care and office visit together. My issue is I was told that the fracture care code includes an office visit unless the office visit is above and beyond such as patient comes in with foot pain and they find patient has a fracture and decide to treat fracture with global care. I have a lot of instances where the patients are diagnosed with fractures in ED or UC then are sent to my Ortho office for treatment. These patients have already been diagnosed with fracture and being sent to my providers for their fracture care. So in these cases can we legitimately charge for an office visit and global fracture care? I have been searching and can not find clear guidelines on this. Any Ortho coders have info to clarify this for me because my Ortho providers will want written proof of the specific rules/guidelines. Thanks!!!
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Wiki Global fracture care and initial office visit
- Thread starter kingt2
- Start date
mitchellde
True Blue
you cannot bill an E&M with a procedure when the procedure is already scheduled or known and/ or the provider does not document a significant E&M over and beyond what is needed to perform the procedure. For instance if the provider documents the need to check for other injuries in addition to the injury the patient was sent for then you could argue a separate E&M. The modifiers indicate that the E&M must be significant ( more than vitals and standard negative responses) and separately identifiable(not a part of the procedure itself.)
Orthocoderpgu
True Blue
I agree with Debra 100%. If your doc diagnosed the fracture, that would be a different situation. But where the patient has already been diagnosed by an ER doc and the patient just needs to follow up with another doc for the fracture care, an E/M would not be warranted since the fracture is already known and been treated. You can bill for X-rays taken during the 90 day fracture care period. And fracture care is also very important. If the bones slip or are not healing ORIF may be necessary. I know a lot of patients think that the doc is getting paid for doing nothing, but that is not true. Bones slip and don't always heal properly so it's important for a doc to follow the fracture to make sure its healing, otherwise the patient will need surgery. Patient education is very important in this situation, they need to understand that they need to be evaluated and why.
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