I am having a bit of difficulty in coding the wound from an open fracture and any help would be great. Patient fell and had an open fracture of the ankle which the orthopod took to surgery and performed an open repair with plates. Before the main fracture open fracture repair, the orthopod took the patient to the OR to irrigate, debride, and perform a closed reduction of the open fracture. The provider planned on going back to the OR the next day. The second surgery by the same doctor, the surgeon created a lateral incision to plate the fracture and he also made an incision over the open wound site (or extended it, hard to tell). Both procedures have a global period and the orthopod is seeing the patient for post op care for the fracture but he also referred the patient to our wound care clinic to be treated for the open wound (where the bone went through the skin) and this wound was left open secondary to healing. The wound from the bone is not infected nor is there any tissue death and our midlevel at the wound care clinic is treating/providng care for the wound (not the surgical incision, but where the bone went through the skin). I do not believe the wound care doctor can bill for this as it is related to the open fracture and there is no complications at this time or at the time of referral. In addition, the patient is still having post op visits for the fracture by the surgeon for the surgical incisions. The wound clinic and the orthopedic doctors are of the same billing group, but I am only coding for the wound care visits at this time. Can the midlevel charge for office visits for this patient or is that considered part of the global period for the original open fracture? Can anyone please help?

Thanks,
L