Fracture Care Coding Guidelines

Fracture Care Coding Guidelines (2022)

Fracture care coding can be billed for closed treatments with or without manipulation. Learn how to bill fracture care with be coding guidelines below. 

1. How To Bill Fracture Care

Fracture care can be billed if the treatment involves materials that allow the separated bones to grow together or support the patient.

Examples of medical supplies for fracture care are;

  • crutches;
  • walking boots;
  • canes;
  • braces;
  • slings;
  • splints; and
  • casts.

No non-operative or non-manipulative fracture care CPT codes can be billed if the provided did not use medical supplies for the fracture care provided or did not plan follow-up fracture care.

Fractures are considered displaced if it is not indicated as non-displaced, and fractures not indicated as open are considered closed.

Facilities in a hospital setting are responsible for billing the medical supplies used for fracture-stabilizing.

Medical supply must be reported separately if an HCPCS II code of fracture care is provided to the patient in the office and billed with POS 11.

The global service of fracture care covers the Initial fittings of strappings, splints, or other medical materials.

Bill additional intraoperative services into fracture surgeries (for example, bone grafts).

2. Modifiers

If the surgeon decides to have surgery on the day before or the day of surgery, modifier 57 needs to be appended to the E/M codes billed for the service. The 57 modifier needs to be included to prevent denials because it can be included in the global package of the procedure.

A patient visit unrelated to the primary fracture care surgery needs to be billed with modifier 24.

Report modifier 58 for non-operative fracture treatment or post-procedurally services.

3. Resources

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53322

https://www.aapc.com/blog/41562-dont-break-your-fracture-care-revenue-cycle/

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