Wiki Is fracture care warranted?

[Alfaro33]

Has anyone had experience with the below scenario with an orthopedic physician in a teaching physician role:

1/5: patient seen in the hospital setting for an elbow disclocation which received a closed reduction by a resident. The teaching physician signed off on the note without supporting their presence or participation in patient management.
1/19: patient follows up in the orthopedic physicians office, splint is removed, PT was ordered, and instructed to come back in 1 month.

Physician wants to bill for fracture care on the 1/19 visit. I feel this would be inappropriate because the fracture care was actually provided on 1/5 however, the provider was not able to satisty the teaching physician guidelines during the hosptial visit therefore, unable to bill fracture care at that time.

Any input would be appreciated.

 

[Youngmedconsult]

This is the age old question of fracture care. When was it done? January 5th. If the requirement for supervision was not met, the full fracture care code cannot be billed for the service performed on January 5th.

When the patient comes into the office of the teaching physician (or any physician in this instance), they could bill an E&M service for evaluating and managing the new problem presented to them of dislocation which is what usually happens. But, depending on the code that would have been used for the reduction of the elbow and adds a modifier 55 for post operative care only. That is really what is being done in ordering PT and having the patient follow up one month later.
Just want to comment - you said the elbow was dislocated, but then you said fracture care. I don't know what codes you were looking at but I see a disparity. Unless it was just the words dislocation and fracture that you were using interchangeably.

 

[amyjph]

No, no billing of the closed treatment 14 days later. That's not what was done, it was done on 1/5. Especially if there was no attestation/participation in your teaching facility example. It comes down to when "restorative/active" care was done too.
I used to have this "discussion" (debate?) with providers all the time in ortho. Their PA or NP would see the patient initially, bill E/M with cast/splint, etc. The surgeon would see the patient in follow up later and want to bill the global. Eh, sorry too late, you (your PA in the same group) already went the E/M route/itemized. You can't now switch. Sometimes the surgeon would even want to do this when they personally saw the patient the first time but charged the E/M method and not the global, then the next visit (or even later) they want to charge the global. No, you shouldn't do that either. You can't have it both ways. You either do the global from the initial or you go the E/M route. There is patient satisfaction and ethical arguments too. It's not right to charge the patient the E/M with casting or splinting and supplies and then turn around and charge the global. Patients also don't understand why their EOB shows a "surgery" when they didn't have surgery not understanding that these CPT are in the surgery section of the book. Unless the practice is really good at explaining they will be in a global and what it means, there are always angry calls later too.
There are other scenarios where maybe a patient was seen in another state or in a separate practice, then they go home and f/u with a new provider. This is where the 54/55 would come in depending on how the first provider billed.

Search fracture care, closed fracture care, non-op fracture care as key words in the forums, there is a lot of discussion about it.
Example - https://www.aapc.com/discuss/thread... have two options with,casting, supplies, etc.)