Basics of Closed Fracture treatment CPT codes

When a patient is initially treated for a traumatic fracture, there are four typical methods of care that are orthopedic physician may provide:

• Closed reduction is a non-surgical manipulation of a fractured bone to restore the bone to normal anatomic alignment
• Percutaneous fixation involves the placement of a stabilizing device such as rod, plate, multiple wires, pins, or screws across a fractured bone, typically under imaging guidance.
• Open reduction with internal fixation (ORIF) is an incisional procedure to realign and fixate separated bone fragments.
• Closed treatment without manipulation involves fitting the patient to appropriate materials for bone stabilization and weight-bearing/non-weight bearing function.

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Closed fracture treatment needs a Medical supply

We have learnt about aftercare and followup fracture coding. But, for the procedure codes involves use of material to immobilize a joint and allow the separated bone parts to fuse together. Materials used are generally casts, splints, braces, canes, walking boots and crutches.

The documentation of the material used for immbolization of joint is very important to indicate the plan for followup care of the fracture, the non-operative non-manipulative fracture care codes then only be reported.

If the documentation does not support or mention any of the medical supply or materials used for closed fracture treatment, then it will be considered as general office visit. In such cases and an appropriate E/M code for subsequent or related visit should be reported.

Although non-operative , non-manipulative fracture care services are not surgical , they carry a 90- day global period. As such, if an E/M service is provided on the same day as fracture care, in such a case modifier 57 decision for surgery must be appended to the E/M code.

Let us checkout the important materials needs to be documented for reporting non-surgical/non-manipulative fracture:

Read also: Sample Coded Surgery Charts for Coders

Important rules for Fracture coding

• Initial fittings of casts, splints, strappings and other materials are included in the global service of fracture care.
• Post-procedurely or after non-operative fracture treatment is provided a subsequent fitting or refitting can be reported with modifier 58 .
• When fracture care is provided in the doctor’s office (POS 11 Office) , materials ,may be reported separately with the appropriate HCPCS level II code. The payer determines whether the supply will be paid.
• In a hospital setting, the facility bills for fracture stabilizing materials.
• A fracture not indicated as nondisplaced is considered displaced.
• Additional intraoperative services may be bundled into fracture surgeries, such as debridement, bone grafts, or old hardware removal.
• If an E/M service is provided on the same day as fracture care (which usually is the case), modifier 57 Decision for surgery must be appended to the E/M code.
• Follow-up visits within the global period can be tracked using 99024 Postoperative follow-up visit, normally included in the surgical package.

Unacceptable, nonspecific documentation, which does not support reporting of non-surgical/non-manipulative fracture care, includes:
Activity modification

• Bed rest
• Dressing change only
• Elevation
• Gait/balance training
• Home exercise program
• Ice (with rest, compression, and elevation)
• Medication prescription (such as for pain control)
• Non-operative/nonsurgical treatment with no elaboration
• Non-weight bearing (NWB) with no elaboration
• Physical therapy
• Proprioception
• “Protected” WB
• Walking aid not specified
• Weight bearing as tolerated (WBAT) with no elaboration

Let use also checkout list of few CPT codes used for treatment of closed fractures in surgery.