Proper Fracture Care Coding Can Improve Reimbursement for Orthopedic Practices

Fracture care is a major part of orthopedic care, whether it takes place in a primary care or family practice setting, or a hospital or emergency room. It also happens to be an area where providers tend to lose a lot of money due to incorrect coding and failing to carefully read EOBs and appeal denials of payment.

Making Difficult Calls

There are over 200 bones in the human body – no wonder orthopedic coding can be so complicated.

It’s crucial for medical staff to have supporting information from official sources such as CMS, AAOS and CPT, and to thoroughly understand the new CCI guidelines concerning factures involving closed treatment without manipulation. For example, the anatomic locations of the portion of the bone involved – from distal to tuft – can be referenced and will affect the correct coding of a fracture.

Other important issues to consider include:

  • Correctly locating the fracture based on anatomic location in order to ensure correct selection of the CPT®and ICD-10 codes
  • Whether to use itemized vs. global fracture care reporting, and whether factures can be reported similarly to a sprain/strain
  • Identifying percutaneous fixation, what the documentation should say and what is considered open treatment of a fracture
  • National Correct Coding Initiative (NCCI) bundling issues regarding closed treatment without manipulation by itself and when reporting with other fracture treatment, including the adding of dislocations

Careful Coding of Fracture Care

Specific things should be located and documented in the coding notes, including the location and classification of the fracture, its presentation, and its treatment. Different types of presentations (open, closed, compound) will determine the coding, but the type of fracture doesn’t have any coding correlation with the type of treatment (closed, open or percutaneous), according to CPT guidelines.

In other words, the presentation of the fracture is how you select the ICD-10 diagnosis code but the presentation of the fracture does not determine how you select your CPT code for the treatment. Treatment is selected based on the fracture will be treated – not how it presented. This is a very important concept that must be understood in order to avoid the wrong CPT code selection.

Train for Fracture Coding

AudioEducator, a leader in training conferences for healthcare professionals, is hosting the live audio conference “Fracture Care – Are You Staying Up with All the NCCI Bundling Issues?” on July 6, 2017 with noted coding expert Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, PCE, MCS-P, ACS-EM, ACS-OR, where she will provide vital information from official sources to assist you in getting your coding right and in getting your claims paid appropriately.

Margie will also be speaking during AudioEducator’s upcoming Coding Updates Virtual Boot Camp 2017, providing key information about the coding changes for 2018 in orthopedics.

To join the conference or see a replay, order a DVD or transcript, or read more

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