Health Information Management

Fracture care without follow-up

APCs Insider, October 28, 2003

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October 31, 2003
Vol. 4, No. 43



In Medieval times, a spider was rolled in butter and swallowed as a cure for what disease?

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What recent celebrity gubernatorial candidate was affected by kidney disease that decreased his growth potential? Name the code.

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Keith Siddel
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

Cheryl D'Amato
director, health information management
HSS, Inc.

Julie Downey
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino

Jeannie Gourgeot
Director of HIMS
St. Joseph's Medical Center

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle
revenue cycle director
Asante Health System




Happy Halloween!

This week's question asks how to code fracture care provided in the ED. Read on for our experts' no-bones-about-it answer.

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.

TODAY'S TOPIC: Fracture care without follow-up

QUESTION: When a patient is seen in the ED for fracture or dislocation and the ED physician applies a cast or splint but does not provide any follow-up care, is it correct to assign the appropriate code from the 29000-29799 range? We have received conflicting information from consultants on this issue.

ANSWER: If the cast or splint is applied because the ED physician confirms the facture, but refers the patient to a specialist for fracture care, bill the appropriate casting/splinting code (29000-29799) along with the appropriate E/M level. Use modifier -25 on the facility E/M code. CPT codes 29000-29799 represent the work to create the immobilization device such as a double sugar tong splint or ulnar gutter splint. Look for documentation of materials used such as stockinette, Webril, plaster, or fiberglass.

However, if the ED physician confirms and treats the fracture, use the appropriate fracture-care code based on fracture site; the initial casting/splinting is included in the fracture care and codes (29000-29799) should not be billed separately. In either scenario, it is acceptable for the provider to bill for the casting or splinting supplies.

PAY PER VIEW: Follow the twists and turns of hernias to the right code.

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ASK THE EXPERT: Should a patient's name be on every page of the medical record? In particular, if an organization uses a tri-fold record, is there a law requiring the patient's name on every page? What are the legal requirements?

Click here for the EXPERT'S answer.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


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