Wiki Stress Fracture CPT

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JessieMcConnell

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I have a new patient that presented w/ foot pain. New patient exam was done w/ x-rays. The patient has a stress fracture. The patient was put in a boot. I was wondering if CPT code 28470 would be appropriate to bill for a stress fracture as I cannot find any information online or in the coding books that support or deny this as an option for stress fractures. Any guidance or information on billing stress fractures would be appreciated. So we were billing 99203, 73630 (LT), L4387(KX,LT) but wasn't sure if we should bill the 28470 as well adding a 57 modifier to the E/M?
 
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This may sound a bit odd, but the answer depends on what your doctor decides to do and it is their decision. Your doctor can choose to bill out office visits every time the patient returns for a follow up visit. Or, your physician can bill fracture care such as 28470, but if this is what your physician wants they MUST document this. As always the documentation must support the code being billed. If the physician chooses to bill fracture care - that decision must be included in the documentation - or the code is not supported. And it's very easy, all they have to document is that they are "initiating fracture care" for this fracture. If the physician has not documented that they are initiating fracture care, the code is not supported. I would add that I would not want the physician to "initiate fracture care" on a fracture that they know they don't need to follow for 90 days or close to that. If it's a simple fracture that the doctor only needs to monitor for a month or two, I would not have them bill fracture care.
 
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Here is a similar question (click me). It does not appear that it matters what type of fracture; it is either closed treatment with manipulation, closed treatment without manipulation, or open treatment.

It would appear from the link that the answer is yes, you bill the 28470.
 
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SharonCollachi said:
Here is a similar question (click me). It does not appear that it matters what type of fracture; it is either closed treatment with manipulation, closed treatment without manipulation, or open treatment.

It would appear from the link that the answer is yes, you bill the 28470.
Click to expand...
Sharon you are 100% correct, you can bill fracture care for a metatarsal fracture and the link you provided supports that. One of the biggest issues with fracture care is its proper documentation. I can tell you from several years of experience that orthopedic physicians almost never actually put in their documentation that they are choosing to bill fracture care over billing E/M visits. Without this decision being documented, the coder does not know which to bill. And it's been my experience that most coders are pressured by their physicians into billing fracture care without any documentation to support it.
 
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