Wiki Is this fracture care?

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jdibble

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Any help I could get with this would be apprecaited!

I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit. I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge. I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.

1. If the patient was seen as an inpatient for say a pelvic fracture and no surgery is done or manipulations or casting (or any other fracture that nothing physically was performed), but the doctor follows the patient in the hospital and then as OP, would this still be considered fracture care or would I bill each indiviual E/M?

2. From the patient history in billing, the doctor saw the patient for the initial care, but I do not show any other visits posted - would I still bill for fracture care if the patient never returned for follow up visits (assuming it was the patient's decision not to return)?

3. Fracture care includes the first cast, however if the cast needs to be replaced during the global period, how would this be billed? Which codes would be used and/or casting supplies billed?

Thanks for any help with this - I have to meet with the Ortho office tomorrow and I would like to go in there with some knowledge of what to tell them. :)
 
jdibble said:
Any help I could get with this would be apprecaited!

I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit. I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge. I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.

1. If the patient was seen as an inpatient for say a pelvic fracture and no surgery is done or manipulations or casting (or any other fracture that nothing physically was performed), but the doctor follows the patient in the hospital and then as OP, would this still be considered fracture care or would I bill each indiviual E/M?

2. From the patient history in billing, the doctor saw the patient for the initial care, but I do not show any other visits posted - would I still bill for fracture care if the patient never returned for follow up visits (assuming it was the patient's decision not to return)?

3. Fracture care includes the first cast, however if the cast needs to be replaced during the global period, how would this be billed? Which codes would be used and/or casting supplies billed?

Thanks for any help with this - I have to meet with the Ortho office tomorrow and I would like to go in there with some knowledge of what to tell them. :)
Click to expand...

1. NO fracture care
2. Yes fracture care if dr actually performed some kind of evaluation of the fx and the first cast or splint application.
3. ex. if this was a Short arm cast I would bill 29075-58 with Q4010 but no Office visit, it would be post op 99024.

That is my opinion on what I would do. :)
 
jdibble said:
Any help I could get with this would be apprecaited!

I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit. I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge. I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.

1. If the patient was seen as an inpatient for say a pelvic fracture and no surgery is done or manipulations or casting (or any other fracture that nothing physically was performed), but the doctor follows the patient in the hospital and then as OP, would this still be considered fracture care or would I bill each indiviual E/M?

2. From the patient history in billing, the doctor saw the patient for the initial care, but I do not show any other visits posted - would I still bill for fracture care if the patient never returned for follow up visits (assuming it was the patient's decision not to return)?

3. Fracture care includes the first cast, however if the cast needs to be replaced during the global period, how would this be billed? Which codes would be used and/or casting supplies billed?

Thanks for any help with this - I have to meet with the Ortho office tomorrow and I would like to go in there with some knowledge of what to tell them. :)
Click to expand...

1. Looks like just E/M since nothing was done (x-ray, casting, manipulation, etc.) for the patient.

2. Fracture care includes and needs follow-up visits as the fracrure care payment includes post-op E/M's in the payment.

3. You can change the cast with supplies (if done in office setting). I use 58 modifier. There's a great AAOS article on fracture care and good CPT Assistant article on cast removal/supplies. Send your email and I'll send over to you.
KM
 
nyyankees said:
1. Looks like just E/M since nothing was done (x-ray, casting, manipulation, etc.) for the patient.

2. Fracture care includes and needs follow-up visits as the fracrure care payment includes post-op E/M's in the payment.

3. You can change the cast with supplies (if done in office setting). I use 58 modifier. There's a great AAOS article on fracture care and good CPT Assistant article on cast removal/supplies. Send your email and I'll send over to you.
KM
Click to expand...
Could I also be sent the link/article from AAOS and CPT Assistant? Thanks so much!
malexander@mainegeneral.org
 
jdibble said:
Any help I could get with this would be apprecaited!

I have been coding an ortho's surgical charts, but now they are missing charges for their office visits and hospital visits and have asked me to do an audit. I have found that the office has somehow missed billing a slew of charges for fracture care and initial E/M and has just been posting the follow up visits as post op, no charge. I am going through these accounts to see what charges are missing and have a few questions since I usually don't do the office charges.

1. If the patient was seen as an inpatient for say a pelvic fracture and no surgery is done or manipulations or casting (or any other fracture that nothing physically was performed), but the doctor follows the patient in the hospital and then as OP, would this still be considered fracture care or would I bill each indiviual E/M?

2. From the patient history in billing, the doctor saw the patient for the initial care, but I do not show any other visits posted - would I still bill for fracture care if the patient never returned for follow up visits (assuming it was the patient's decision not to return)?

3. Fracture care includes the first cast, however if the cast needs to be replaced during the global period, how would this be billed? Which codes would be used and/or casting supplies billed?

Thanks for any help with this - I have to meet with the Ortho office tomorrow and I would like to go in there with some knowledge of what to tell them. :)
Click to expand...




1) I would disagree with others on this one. We bill fracture care for closed treatment w/o manipulation (27193) if the doctor is following the patient in the hospital and will follow after discharge. If no follow up then we would bill the E&M instead.
2) We bill this as fracture care if the patient is expected to follow up with our office.
3) We bill using the appropriate casting application code and Q-code for supplies.

Debbie
Ortho Surgeons, Inc.
 
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