Billing and Coding: Fracture Care Many times the initial treating physician
does not provide all of the follow-up care after surgery. View examples of
acceptable ways to bill for definitive or restorative treatment of a fracture.  
  
**Coding and Billing Options**  
  
**Claim Coding Example #1**  
  
When the surgeon does not provide any of the follow-up care for the 90 day
global payment period, the surgeon bills the closed treatment of radial shaft
fracture as follows:  
Date|  Place of Service|  CPT/Modifier|  Charge|  Units  
---|---|---|---|---  
2/15/2014|  Applicable Code|  25500 54|  $$|  1  
  
  
Second physician bills the follow-up care for the closed treatment of radial
shaft fracture as follows:  
Date|  Place of Service|  CPT/Modifier|  Charge|  Units  
---|---|---|---|---  
2/15/2014|  Applicable Code|  25500 55  
|  $$|  1  
  
Documentation in item 19 of 1500 claim form: 2/16/2014- 5/16/2014  
  
**Claim Coding Example #2**  
  
When post operative care is provided by both physicians (45 days each), the
surgeon bills the closed treatment of radial shaft fracture as follows:  
Date|  Place of Service|  CPT/Modifier|  Charge|  Units  
---|---|---|---|---  
2/15/2014|  Applicable Code|  25500 54|  $$|  1  
2/15/2014  
|  Applicable Code|  25500 55|  $$|  1  
Document in item 19 of 1500 claim form 2/16/14-4/1/2014  
  
Second physician bills the closed treatment of radial shaft fracture as
follows:  
|  Date|  Place of Service|  CPT/Modifier|  Charge|  Units  
---|---|---|---|---  
2/15/2014|  Applicable Code|  25500 55|  $$|  1  
  
Document in item 19 of 1500 claim form 4/2/2014-5/16/2014  
  
If the decision to have surgery was made by the surgeon on the day before or
the day of surgery, a modifier 57 needs to be appended to the evaluation and
management code used. Without this modifier, your visit will be denied as
included in the global package of the surgery.  
  
If a patient visit occurs after surgery which is unrelated to the surgical
procedure, a modifier 24 must be appended to the evaluation and management
code.  
  
To assist physicians and practitioners to select the correct code for the
casting, splinting and splinting supplies, the following crosswalk provides
guidance on which supply code are applicable for the various types of casts
listed by Level I CPT codes.  
  
The splints and cast Q codes are considered Level II codes and to be used when
supplies are indicated for cast and splint purposes. The payment is in
addition to the payment made under the physician fee schedule for the
procedure for applying the splint or cast.  
  
**_Level I_**|  **_Level II_**|  **_Level I_**|  **_Level II_**  
---|---|---|---  
29000|  Q4001 or Q4002|  29126|  Q4021 through Q4024  
29010|  Q4001 or Q4002|  29130|  Q4049  
29015|  Q4001 or Q4002|  29131|  Q4051  
29020|  Q4001 or Q4002|  29305|  Q4025 through Q4028  
29025|  Q4001 or Q4002|  29325|  Q4025 through Q4028  
29035|  Q4001 or Q4002|  29345|  Q4029 through Q4032  
29040|  Q4001 or Q4002|  29355|  Q4029 through Q4032  
29044|  Q4001 or Q4002|  29365|  Q4033 through Q4036  
29046|  Q4001 or Q4002|  29405|  Q4037 through Q4040  
2949|  Q4050|  29425|  Q4037 through Q4040  
29055|  Q4003 or Q4004|  29435|  Q4037 through Q4040  
29058|  Q4003|  29440|  Q4050  
29065|  Q4005 through Q4008|  29445|  Q4037 through Q4040  
29075|  Q4009 through Q4012|  29450|  Q4035, Q4036, Q4039  
29085|  Q4013 through Q4016|  |  Q4040  
29105|  Q4017 through Q4020|  29505|  Q4041 through Q4044  
29125|  Q4021 through Q4024|  29515|  Q4045 through Q4048  
  
  
The allowance for application of a cast, splint or strapping includes removal
or repair by the same physician or other physician in the same group. Billing
for cast removal or repair (29700-29750) should be employed only for casts
applied by another physician group.