Domain: Healthcare & Social Assistance
Question:
Fracture and Dislocation Care:

Case Scenario 1-An emergency physician evaluates a patient with a displaced distal fibula fracture. During the visit, the physician applies traction to improve alignment before placing a splint. Post-splint imaging shows improved positioning, but no formal reduction note is documented. During coding review, there is disagreement about whether fracture care with manipulation may be reported. How should this encounter be coded, and what documentation factors determine whether manipulation-based fracture care is appropriate?
Case Scenario 2- A patient returns to the emergency department two days after an initial fracture visit due to increased pain and swelling. The fracture was previously splinted without manipulation. During the return visit, the splint is adjusted, pain medications are changed, and repeat imaging is reviewed. How should the second encounter be coded, and what factors prevent fracture care codes from being reported again?

Expected points in a correct answer:
States that fracture care with manipulation requires explicit documentation of intentional fracture reduction
States that fracture manipulation is determined by intentional reduction of the fracture rather than limb positioning for immobilization
States required documentation describing the specific reduction technique used during fracture manipulation
States that documentation must confirm improved alignment following reduction, including a formal reduction note
States that post-procedure imaging must support reporting fracture care with manipulation
States that a formal reduction note must be included in the documentation
States that reporting fracture care with manipulation is inappropriate when documentation does not confirm intentional reduction and post-procedure assessment
States that reporting fracture care with manipulation implies assumption of global fracture management responsibility
States that appropriate use of E/M with splint application reflects evaluation-focused management when reduction is not performed
States that fracture care coding requires distinguishing between definitive treatment and follow-up or aftercare services.
States that fracture care codes represent a bundled, definitive service
States that fracture care codes should not be repeatedly reported for the same injury without new fracture management
States that splint adjustment is considered follow-up or aftercare and does not constitute new fracture treatment
States that imaging review alone is considered follow-up or aftercare and does not constitute new fracture treatment
States that symptom management alone is considered follow-up or aftercare and does not constitute new fracture treatment
States the second encounter to be reported using an evaluation and management (E/M) service
States that the E/M service level must be supported by documented evaluation and medical decision-making
Requires documentation to clearly indicate that the encounter addressed follow-up care rather than definitive fracture treatment
States that clear documentation of fracture care treatment intent strengthens audit defensibility for fracture care reporting
States that failure to clearly document follow-up status may result in duplicate billing and payer recoupment
States that distinguishing follow-up care from definitive fracture treatment supports audit defensibility
States that simply applying traction to improve alignment during splint placement does not automatically qualify as manipulation for coding purposes
States that the Scenario 1 encounter should be reported using an E/M code along with a splint application code
States that the provider must have deliberately attempted to realign the fracture for manipulation-based coding
States that fracture care is typically billed only once per injury unless a new manipulation or surgical intervention takes place
States that the absence of documented reduction attempt, reduction technique, pre- and post-reduction assessment, or physician statement makes fracture care coding inappropriate in Scenario 1
States that compliance risk is a consequence of failing to properly distinguish follow-up care from definitive fracture treatment