Posted on 12. Oct, 2009 by in Hot Coding Topics
No maybes here: Answer this question wrong and you will code incorrectly.
When your ED physician performs fracture care for a patient, be ready to pounce on evidence of manipulation, as CPT often breaks fracture care codes along the manipulation line.
The $kinny: Let’s say the physician performs closed treatment on a fractured collarbone; if she uses manipulation, the service is worth about $106 more than a nonmanipulation encounter.
Use this FAQ to successfully manipulate both types of fracture care codes — and ethically add to the practice’s bottom line.
What Is Manipulation?
For coding purposes, “manipulation involves reduction or attempted reduction of the fracture or dislocation,” explains Gerri Walk, RHIA, CCS-P, senior manager for Baltimore’s Health Record Services Corporation.
There is “open” manipulation, but your ED physicians will almost always perform “closed” manipulation, which occurs when “the physician is repositioning or relocating a displaced closed fracture back to the correct anatomical position without surgically opening it,” says Nicole Benjamin, CPC, CEDC, coding education specialist for the American Academy of Professional Coders (AAPC).
When the ED physician provides manipulation, make sure he remembers to document it, “since an orthopedic doctor can be called to treat these fractures as well,” Benjamin recommends. If you don’t ID manipulation, you could end up costing your ED deserved cash on certain fracture fixes.
Payout: Let’s look at CPT codes for closed treatment of a fractured collarbone: 23500 (Closed treatment of clavicular fracture; without manipulation) and 23505 (… with manipulation). Code 23500 pays about $184 (5.09 transitioned facility relative value units [RVUs] multiplied by the 2009 Medicare conversion rate of 36.0666); while 23505, with 8.05 RVUs, pays about $290.
How Can I Identify Manipulation?
Unfortunately, the word “manipulation” does not make its way into physician encounter notes very often, reports Denise Katz, coder for Dr....
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