Tag Archives: fracture
Check for Fracture Diagnosis Before Coding Repair
Posted on 23. Apr, 2010 by Editor.
Don’t code a closed fracture treatment code without more information.
Question: Our orthopedist saw a patient in the emergency department for a gunshot wound and diagnosed a metacarpal fracture. He irrigated the site and removed a foreign body. Can we also report a fracture code even though he didn’t manipulate the fracture?
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Answer: If the documentation lists the fracture as a diagnosis (815.1x, Fracture of metacarpal bone[s]), you can code fracture care along with irrigation 20103 (Exploration of penetrating wound [separate procedure]; extremity).
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Second Surgery Coding: Tips for Modifier 58, 78 Success
Posted on 19. Jan, 2010 by sanjay.aikat.
Don’t let ‘unplanned’ lead to ‘unpaid.’
The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else.
Check for Surprise Versus Planned
Two modifiers pertain to follow-up trips to the OR, but knowing the basic difference helps you choose the right one:
• Modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) represents an expected return to the OR. This could be because the original surgery normally is performed during multiple sessions or the follow-up is more extensive than the original procedure. “The patient’s condition dictates the additional service or the service was planned prior to the original surgery,” explains Linda Parks, office manager for Herrin Family Medicine in Lilburn, Ga. You can also report modifier 58 for non-OR sessions, such as planned therapy following surgery.
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Fracture Care Coding: Mark Manipulation, Make $100+ More Per Encounter
Posted on 12. Oct, 2009 by Editor.
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.
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Orthopedic Coder’s Anatomy: The Hip
Posted on 26. Sep, 2009 by Editor.
These key terms make coding for hip procedures easier and more accurate.
If you think your hip is that thing jutting out at you in the mirror, your nomenclature needs a rehaul to ensure you’re nailing the correct codes. Coding for hip fractures and other procedures is easier when the coder is hip to the anatomy and terminology.
Common mistake: The average person refers to the prominent part of the pelvis that juts out just below the waistline (the iliac crest) as the hip. However, the hip portion of the pelvis is really about five inches below and is called the acetabulum, or “true hip.”
The ABCs of Hip Anatomy
Hip joint: Three areas of the pelvic structure form the acetabulum or the socket: the ilium, the ischium, and the pubis.
Femoral head: This is the “ball,” which is located in the upper end of the femur. The femoral head and the acetabulum are covered with a layer of cartilage that provides shock absorption and load distribution within the hip.
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Solve Op Note Mysteries With This Fracture Glossary
Posted on 10. Aug, 2009 by Editor.
CPT code selection is easier if you know your fracture anatomy. Illustrations included!
Fractures are defined as a disruption in the integrity of a living bone, bone marrow, periosteum, and adjacent soft tissues. Fractures occur when a bone cannot withstand outside forces, the integrity of the bone has been lost, and the bone structure fails. Fracture care usually involves the expertise of an orthopedic physician who monitors the fracture’s healing. The ultimate goal is to secure union and to restore normal function.
Fracture healing involves 5 phases:
- fracture and inflammatory phase
- granulation tissue formation
- callus formation
- lamellar bone deposition
- remodeling
Become Familiar With Site Vocab
Orthopedic coders also need to understand the many eponyms and terms that pertain to specific fracture. They will help you to recognize a fracture’s location. They are:
Bankart fracture — This is usually seen with an anterior dislocation of the shoulder where a small piece of bone is detached from the anteroinferior rim of the glenoid bone.
Bennett fracture — The thumb is dislocated dorsally at the metacarpal. There is often an associated avulsion of the metacarpal on the volar surface of the metacarpal articular surface.
AUDIO: Coding Essentials for knee procedures.
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Sort Out This ER, Then Assumed Care Scenario
Posted on 10. Aug, 2009 by Editor.
Question: My orthopedist treated a patient who was first seen in the ER for an open fracture with laceration overlying the distal finger phalanx. The ER physician sutured the wound. When the patient arrives in our office, the orthopedist does an E/M service and assumes the care of the wound in addition to the fracture care. Should I report our orthopedist’s E/M service or does that qualify as double-dipping?
Answer: If your orthopedist didn’t do anything in addition to treating the fracture (such as splinting, casting, and so on), then you should bill the E/M service (such as 99214, Office or other outpatient visit …). You might try applying modifier 55 (Postoperative management only), but you need to make sure the service the ER physician performed has more than a “0” day global. Many wound repair codes are minor procedures that have 10 day global periods.
If your orthopedist treated the fracture, you should report the appropriate fracture code. Your facture code could be 26750, Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each, or 26755, … with manipulation, each, depending on whether the orthopedist performed the manipulation).
AUDIO: E/M for Ortho. Where are you losing money?
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ICD-9 Coding Tool for Hand, Wrist Fractures
Posted on 31. Jul, 2009 by Editor.
Here’s how to differentiate the tiquetrum from the trapezium.
Orthopedic surgeons dealing with hand procedures don’t only treat dislocations — they also treat fractures, and it’s up to you to link the correct diagnosis to the upper-extremity fracture repair code.
Use the anatomic drawing here to locate the site that your surgeon addressed, and match that to the sampling of applicable ICD-9 codes in the chart at the bottom of this page.
Your hand surgery claims will come out picture-perfect, and denial-free. 
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Orthopedic Coder’s ICD-9 Update: New Radius, Ulna Torus Fracture Codes
Posted on 03. Jul, 2009 by Editor.
Come Oct. 1, you’ll no longer will you look to 832.0 for nursemaid’s elbow.
Does your orthopedist treat children’s arm problems with regularity? If so, then you may have three new ICD-9 codes to use as of Oct. 1. Take advantage of this sneak peak at the proposed orthopedic additions, and you’ll be ahead of your peers.
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Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately. Orthopedic coders, however, had hoped for a wider range of codes, says Leslie A. Follebout, CPC, COSC, PCS, coding manager at Peninsula Orthopaedic Associates in Salisbury, Md.
For instance, you may not celebrate the addition of fifth digits to existing codes 274.0 (Gouty arthropathy) and 453.8 (Other venous embolism and thrombosis of other specified veins). You may, however, find some brand-new additions.
Here’s 3 New Codes to Use in Pediatric Cases
If your orthopedist treats pediatric patients for fractures, then you’re used to applying forearm fracture ICD-9 codes. These constitute nearly half of all childhood fractures. ICD-9 2010 may bring you two new torus fracture options: 813.46 (Torus fracture of ulna [alone]) and 813.47 (Torus fracture of radius and ulna).
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