coding303
Networker
I am in need of some real help here. I do not have access to Coding Clinics or any other various electronic references as I work for an independent Urgent Care facility and the only items provided to me are my CPT, ICD-9, and HCPCS text I am having trouble coding as everything that I do is questioned as I am the first certified coder they have had. Here is what I am facing today, any and all help is IMMENSELY APPRECIATED
Here is my situation: I have a provider who insists on billing fracture care. I have explained that most Urgent Care facilities do not bill global fracture care but that it is possible to do with a 54 modifier as we provide initial care. I have specifically be told to code and release charges without a modifier. "do not use modifier 54" This is an issue of much discussion between us lately and currently the 54 modifier remains.
Also, when reviewing documentation I have notes that have x-ray interpretation of "possible fracture" in the note and providers who give the diagnoses of fracture with discharge instructions that state "possible fracture". Since the physician has given the diagnoses of fracture he wants this visit to go out as a fracture with fracture care code as well. I do not feel comfortable with this as the x-ray does not show fracture and radiologist only states "possible". I understand that is the management and care that is provided but in an outpatient setting it is the presence of "possible" that leads me to believe it should not be done.
What I am hoping to have a little help with is finding information that I can present explaining that we can/cannot bill fracture care for a patient whose x-ray did not show a definitive fracture. This is my first position where coding fracture care is even a possibility so any education is helpful as well.
Here is my situation: I have a provider who insists on billing fracture care. I have explained that most Urgent Care facilities do not bill global fracture care but that it is possible to do with a 54 modifier as we provide initial care. I have specifically be told to code and release charges without a modifier. "do not use modifier 54" This is an issue of much discussion between us lately and currently the 54 modifier remains.
Also, when reviewing documentation I have notes that have x-ray interpretation of "possible fracture" in the note and providers who give the diagnoses of fracture with discharge instructions that state "possible fracture". Since the physician has given the diagnoses of fracture he wants this visit to go out as a fracture with fracture care code as well. I do not feel comfortable with this as the x-ray does not show fracture and radiologist only states "possible". I understand that is the management and care that is provided but in an outpatient setting it is the presence of "possible" that leads me to believe it should not be done.
What I am hoping to have a little help with is finding information that I can present explaining that we can/cannot bill fracture care for a patient whose x-ray did not show a definitive fracture. This is my first position where coding fracture care is even a possibility so any education is helpful as well.
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