Article - Billing and Coding: Fracture Care (A53322)

CMS National Coverage PolicyN/AArticle TextMany 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 OptionsClaim Coding Example #1When 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:DatePlace of ServiceCPT/ModifierChargeUnits2/15/2014Applicable Code25500 54$$1Second physician bills the follow-up care for the closed treatment of radial shaft fracture as follows:DatePlace of ServiceCPT/ModifierChargeUnits2/15/2014Applicable Code25500 55$$1Documentation in item 19 of 1500 claim form:  2/16/2014- 5/16/2014Claim Coding Example #2When post operative care is provided by both physicians (45 days each), the surgeon bills the closed treatment of radial shaft fracture as follows:DatePlace of ServiceCPT/ModifierChargeUnits2/15/2014Applicable Code25500 54$$12/15/2014Applicable Code25500 55$$1Document in item 19 of 1500 claim form 2/16/14-4/1/2014Second physician bills the closed treatment of radial shaft fracture as follows:DatePlace of ServiceCPT/ModifierChargeUnits2/15/2014Applicable Code25500 55$$1Document in item 19 of 1500 claim form 4/2/2014-5/16/2014If 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 ILevel IILevel ILevel II29000Q4001 or Q400229126Q4021 through Q402429010Q4001 or Q400229130Q404929015Q4001 or Q400229131Q405129020Q4001 or Q400229305Q4025 through Q402829025Q4001 or Q400229325Q4025 through Q402829035Q4001 or Q400229345Q4029 through Q403229040Q4001 or Q400229355Q4029 through Q403229044Q4001 or Q400229365Q4033 through Q403629046Q4001 or Q400229405Q4037 through Q40402949Q405029425Q4037 through Q404029055Q4003 or Q400429435Q4037 through Q404029058Q400329440Q405029065Q4005 through Q400829445Q4037 through Q404029075Q4009 through Q401229450Q4035, Q4036, Q403929085Q4013 through Q4016Q404029105Q4017 through Q402029505Q4041 through Q404429125Q4021 through Q402429515Q4045 through Q4048The 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.