These Frequently Asked Questions are provided to assist you with common orthopaedic coding issues.
Check back monthly for updated topics.
This Month's Topic:
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Our surgeon recently heard that he can bill individual visits instead of fracture care for patients seen in the ER. Is billing for fractures like this an option? |
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In the case of non displaced or minimally displaced fracture, the AAOS has determined two options for reporting services. Assuming the payor accepts either method, the service may be reported using the non manipulation global fracture codes or the services may be “itemized billed.”
If the services are reported using the global fracture codes, the service includes the first cast application and 90 days of post operative care. If the services are reported using the itemized method, the physician does not report a global fracture code, but instead reports E&M-25, cast/splint application at each visit where the services are medically necessary. There is no global period associated with itemized billing. |
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If a patient presents with multiple fractures, can you bill individually for each visit each time the area is evaluated? |
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If a patient presents with multiple fractures, we assume the physician would report global fracture codes. If the physician is treating a patient who has a combination of displaced/non displaced fractures and reports the displaced fractures with global fracture codes and the non displaced using the itemized method, then assuming there is documentation of medical necessity and services reported, the E&M -24 linked to the non displaced fracture would be reported at each session. The patient may not understand why some services are being treated as global fracture services and some reported using the itemized method. |
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