Vital Insights into Fracture Care Coding

by Outsource Strategies International Medical Billing Company Medical coding can be complex and tricky to handle for services such as fracture care. It is important to include casting and strapping, and E/M whenever necessary with ankle and foot fracture care. Not doing so would affect reimbursement quite significantly. Here are some points podiatrists need to remember while coding for fracture care services.

Matching Fracture Treatment with Criteria

Fracture treatment should be matched with criteria. Fracture care must be reported if:

• You are the first physician the patient visits for the injury which is recent and has not healed by itself
• Surgery has not been performed on the patient by any other physician in another practice, and
• You provide a restorative procedure and plan to care for the injury in the following 90 days  

For instance, if a patient has pain and swelling in the ankle following an injury the previous day, and the podiatrist detects ankle fracture of the closed bimalleolar kind and carries out closed treatment sans manipulation, the following code should be used for billing:

• CPT 27808 - Closed treatment of bimalleolar ankle fracture; without manipulation linked to ICD 824.4 (fracture of ankle; bimalleolar, closed)

Reporting E/M Service Instead of Fracture Care

Sometimes you may have to report E/M service (CPT 99201-99215) rather than fracture care. The right casting and strapping codes (CPT 29000-29590) must be also applied when necessary. Here are the criteria for adding E/M codes:

• It is an old fracture
• There is a nonunion of the fracture
• That fracture has healed or mostly healed
• No restorative procedure or treatment is provided for which the physician goes to assume follow-up care for the following 90 days
• Follow-up visits are not recommended by the physician
• The patient is referred to a procedure that is more extensive such as open treatment with or without fixation

Append Modifier 25 to E/M Code

If modifier 25 is not appended to the E/M code while coding cast and strapping application (29000-29590) and E/M service, physician reimbursement will suffer. Modifier 25 indicates “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service”.

If, for example, the ankle of an established patient is strapped following a level-two E/M, the codes reported should be

• CPT 29540 - strapping, ankle and/or foot)
• CPT 99212 - Office or other outpatient visit for the evaluation and management of an established patient, that needs at least two of the following components: a problem-focused history; a problem-focused examination; straightforward medical decision making

Modifier 25 should be linked to 99212 to reveal that strapping and E/M were performed separately.

Note that CPT 99070 is part of the procedure and must not be billed separately. Code 99070 indicates supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered.

Ensure Higher Payments with Fracture Care Codes

Larger payouts must be generated with fracture care codes. Never miss the chance to report fracture care and don’t habitually bill E/M code with the appropriate casting code, since failing to report fracture care could result in a loss of about $100 per claim.

For instance, for a patient diagnosed with a big toe fracture, the physician may strap the toe to one adjacent to it. No distinct E/M service is reported. There is no reference to an orthopedist and the physician may provide follow-up service. In this case, there are two code choices:

• CPT 28490 - Closed treatment of fracture great toe, phalanx or phalanges; without manipulation

• CPT 29550 - Strapping; toes

Here, higher payout can be ensured by reporting the fracture care with CPT 28490 since this offers 4.46 RVUs, 90 global days and payment of $151.74. In contrast, CPT 29550 only has 0.95 RVUs and zero global days, which results in a payment of just $32.22.

Reporting Follow-up Visits

Special attention should be paid to reporting follow-up visits. Fracture care codes could include follow-up care but there are times when the physician will have to code separately for follow-up visits. Code selection must be based on the reason presented by the patient for the visit as well as the following factors:

• If E/M service in the global period does relate to the initial procedure, follow-up care should be reported with 99024 and $0 charge
• If the physician sees the patient for any unrelated problem within the global period, modifier 24 should be added to the E/M service.

About Outsource Strategies International

Outsource Strategies International (OSI) is a premier medical coding company based in Tulsa, Oklahoma with offices throughout the US. Our accurate and timely medical coding would help you secure prompt payment for covered services.For more information, call us toll free at: 1-800-670-2809 and speak to our senior solutions manager.
           

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Created on Dec 31st 1969 18:00. Viewed 0 times.

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