:confused:
How do I code for a old fracture found on an xray? Is this a hx code?
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Tag Archives: Fracture
Bone biopsy with orif pathological fracture
If the Orhto doctor is seeing the patient due to pathological fracture and decides to perform bone biopsy,sends to path and turns out to be malignant can the bone biopsy be with modifier 59??
new injury rebeaking the right distal humerous over an healed fracture with a metal
It’s Risk adjustment, so I’m coding an acute fracture of the right distal humerus: S42.201a. But the x-ray shows a surgical plate with screws so Should I code a S42.201D? or is there a better code of rebreaking the same bone at the site of an old fracture?
Code for compression fracture lumbar
Does anyone have any idea what diagnosis code should be used when a patient comes with compression fracture of lumbar for kyphoplasty procedure
Fracture care vs. E/M
I get a little confused on when to bill out a fracture care code vs. E/M’s or if both should be used, this example is for the clinic pro-fee. Curious if I could get some insight on how others would code this case:
Patient comes into the clinic and is evaluated, and after x-rays is diagnosed with a radial fracture. The provider applies a short arm cast (no manipulation), and requests that the patient return in 3 weeks for another set of x-rays.
The patient returns after 3 weeks, the x-ray shows a healing fracture, and decides the cast can come off- and sends the patient home in a pre-fab splint. He asks her to return again in 3 weeks. Would you use a fracture care code, for the first visit or just an e/m w/the application of the short arm splint (29125). All follow-up is w/ the same provider in the same clinic. Thanks for any help! I just want to make sure I am understanding these types of encounters!
Jackie CPC, CEMC, CPMA
Help with fracture coding
Hi everyone! I have a podiatrist that is trying to bill fracture care for a patient but the xray and bone scan are not showing any fractures.
X-ray Foot Left 2 Views
Narrative: Lateral calcaneal axial the left heel. Bone spur present on the inferior heel. No change from prior exam. No evidence of stress fracture. Assessment: Left foot with plantar calcaneal spur and no acute findings
X-ray Foot Left 2 Views
Narrative: Lateral calcaneal axial the left heel. Bone spur present on the inferior heel. No change from prior exam. No evidence of stress fracture. Assessment: Left foot with plantar calcaneal spur and no acute findings
Nm Bone Scan Three Phase
Exam:NM bone scan three phase Diagnosis:Pain Calcaneal spur, left Chief complaint: Left calcaneal?bone pain History: Pt is a runner and has had chronic Left heel pain since summer 2018 Additional Tech Information: Administered dose: 25.5 mCi Tc-99m MDP PROCEDURE Three-phase bone scan Images were centered over the feet and ankles after radiotracer administration COMPARISON Left foot x-ray from January 14 FINDINGS There is not significant asymmetry on blood flow On the delayed images there is some intense activity along the left plantar calcaneal spur with perhaps very mild asymmetric activity in that region on the blood pool image There is also subtle asymmetric blood and intense delayed activity near the tarsometatarsal joint near the base of the third or fourth metatarsal at the left mid foot with similar but less impressive activity on the right side on delayed imaging There is otherwise some focal activity at the right mid foot Lisfranc articulation on delayed imaging IMPRESSION: Intense delayed activity at the left calcaneal spur region with only mild low-level blood pool activity. This may be sequelae of prior plantar fasciitis. Acute active plantar fasciitis or stress injury is less likely There is some mild blood pool and delayed activity at the left mid foot near the articulation of the cuboid or cuneiform with the base of the fourth and third metatarsal region. This could be arthritic or related to a stress injury There is also some delayed activity at the right foot midfoot and Lisfranc articulation If this patient has persistent or worsening symptoms and more detailed imaging is needed, MRI might be considered assuming no contraindication. ———————————————————————–
I had advised the provider that we could not bill for fracture care because there was not a fracture or even a stress fracture, that likely is not allowed. The provider is arguing with me. Here is his response:
Patient has disabling pain on the plantar heel for 6 months that is consistent with fracture. She describes pain at rest which is consistent with bone pain and not plantar fasciitis. Radiologist stated:
Intense delayed activity at the left calcaneal spur region with only mild low-level blood pool activity. This may be sequelae of prior plantar fasciitis. Acute active plantar fasciitis or stress injury is less likely
So this is not a prior plantar fasciitis. She still has pain. This is not just plantar fasciitis with her complaint of pain when at rest. Patient does not have an infection in her heel. There is no evidence of tumor on the x-ray. Diagnosis of calcaneal stress fracture is most likely. She is being treated for a stress fracture in a cast boot. So this may be less likely to the radiologist but it is my opinion that fracture is the most likely diagnosis based on the patient’s symptom patterns.
I think the code should stay
I cannot find any documentation to support that we cannot bill for less likely or most likely fractures that are in the drs opinions. Can anyone please help me?
HELP! femoral fracture coding advice needed
Patient was treated for an upper femoral fracture 5 weeks ago. Reported with 27245. She fell during the global period, injuring her lower femur.
To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one – so I think for that we code S72.142A – 27245 (78) and then for the lower femur S72.452A – 27511-79???.
To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one – so I think for that we code S72.142A – 27245 (78) and then for the lower femur S72.452A – 27511-79???.
Also, should I bill for removal of the first rod with a 20680?
Thank you!
HELP! femoral fracture coding advice needed
Patient was treated for an upper femoral fracture 5 weeks ago. Reported with 27245. She fell during the global period, injuring her lower femur.
To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one – so I think for that we code S72.142A – 27245 (78) and then for the lower femur S72.452A – 27511-79???.
To fix the lower femur, we had to remove the femoral rod and replace it with a smaller one – so I think for that we code S72.142A – 27245 (78) and then for the lower femur S72.452A – 27511-79???.
Also, should I bill for removal of the first rod with a 20680?
Thank you!
Can I code fracture care?
Please advise:
I have been told by our outside auditors that I need to charge for the fracture care along with the laminectomy/fusion.
Is this correct?
PREOPERATIVE DIAGNOSIS: L2 burst fracture.
POSTOPERATIVE DIAGNOSIS: L2 burst fracture.
NAMES OF OPERATION:
1. L2 laminectomy.
2. T12-L4 percutaneous pedicle screw fixation with DePuy Synthes spine Viper Prime system.
who fell from a height onto his back while working at a house and sustained an L2 burst fracture. Fortunately, he was neurologically intact but had a tight canal at L2. He was offered the above surgery for decompression as well as stabilization of the unstable burst fracture.
PROCEDURE IN DETAIL: The patient was brought to the OR and was given general endotracheal intubation and anesthesia. He was then transferred to the operating table and placed in a prone position with all pressure points well buffered. The intraoperative CT Airo system was used. Neurophysiological electrodes were also placed before and after positioning and were found to be stable. The back was then prepared using Betadine and he was draped in a sterile fashion. Lidocaine 1% lidocaine and 1:200,000 epinephrine were then infiltrated along the planned incision line. A scout film was performed with a CT scan and the T8 spinous process was exposed and the BrainLAB reference arm was then clamped onto this spinous process. The patient then underwent a CT scan spanning the T10-L5 levels. Attention was then turned towards the L2 decompression, and a small incision over the L2 area was then performed in the midline. The paraspinal muscles were dissected and the spinous processes of L2 were entirely removed, as well as the inferior half of the L1 spinous process. The laminectomy was then performed and a good decompression was accomplished at that level. Hemostasis was achieved and the wound was irrigated with bacitracin saline.
Attention was then turned towards putting the percutaneous pedicle screws. Small stab wounds were made approximately 3 cm lateral to the midline as guided by the navigation system. The DePuy Synthes spine Viper Prime system was used throughout the procedure and the screws placed and confirmed having good placement using the intraoperative CT. Each screw was also stimulated and found to have a high amplitude of stimulation, all above 20. The stab wounds and the reference array was taken off and irrigated with bacitracin saline. The wounds were closed with 0 Vicryl to the deep fascial layer, 2-0 Vicryl to subcutaneous layer and staples applied to the skin. A Hemovac drain was placed in the laminectomy wound. Then, 0.5% Marcaine was
infiltrated along the wounds postoperatively
Closed Reduction Thumb Fracture
Hi everyone!
Can anyone help me code for a closed reduction and percutaneous pinning of intra-articular proximal phalanx fracture of the thumb? The two codes I am looking at are 26727 and 26742. I can’t decide which one is right because 26727 specifies proximal phalanx, while 26742 specifies articular. Any suggestions?
Thanks!:)