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Closed Reduction W/o Manipulation Code Billed the Day Prior to ORIF

Good afternoon,

My orthopedic surgeon wants to bill for a closed reduction w/o manipulation code (24500) on 6/8 and bill for the ORIF (24515) on 6/9 (the following day). I advised the provider that all he did on 6/8 was assessed the condition and plan for surgery therefore, 24500 is not separately billable. According to the guideline I’m currently reviewing "if plan is for manipulative procedure at a future date, non-manipulative fracture management should not be billed" If however, "treatment is instituted, with the possibility for a manipulative procedure at a future date, bill non-manipulative fracture management". In this case, the provider already knew and planned for surgery the next day.
My understanding is that closed reduction codes without manipulation involve treating a fracture until is healed that’s why they carry a 90-day global day.
My provider wants me to add modifier 58 to the ORIF code but I think is inappropriate. I honestly think all he should be billing for 6/8 is the E/M code along with modifier 57 and for 6/9 bill for the ORIF.
Any opinions will be appreciated.

Thank you.

Medical Billing and Coding Forum

CMS E/M Services Documentation Guidelines and Burden Reduction Listening Session

So this post is more of a discussion post, rather than posing a question. However, in case you missed it, CMS held a special E/M listening session where stakeholders and other folks from the community were invited to call in and comment on a number of questions. The intention was to learn from stakeholders and the community which direction they would like the E/M guidelines to change. CMS does acknowledge that the current 1995/1997 E/M guidelines are cumbersome and would like to update them, hence the Listening session held March 21st of this year. CMS did also mention that this process might be multi-year, however some people are hopeful that some updates might even start next year (2019).

Since I deal with E/M audits on a daily basis, I am seriously excited about this upcoming change. I wholeheartedly agree that the current E/M guidelines are in a need of an overhaul. I am very interested to see which direction CMS will end up taking with the comments during the Listening session. The reason for this post is not just to notify the AAPC forum, but also to pick other coders’ brain on this upcoming change.

Here is the transcript link from the session:

E/M Services: Documentation Guidelines and Burden Reduction Listening Session

Medical Billing and Coding Forum

Standards for additional reimbursement or reduction with modifiers

Hello,
I know many are at the discretion of the payer but is there a set standard that payers go by when determining if a modifier warrants additional payment (ie. -22) or reduction (ie. -52) and by what percentage? If so, who sets this standard?

Thank you.

Medical Billing and Coding Forum

CR vs DR radiology cms reduction

Does anyone know, now that Medicare is reducing payments for CR vs. DR radiology, do we need to attach a modifier or something to our radiology codes to notify CMS of what x-ray equipment we have? similar to the FX modifier for plain film?
I cannot find any info on this, and am wondering how would Medicare know what equipment we even have?
Thanks!

Medical Billing and Coding Forum

Reduction at bedside

preop dx: Gunshot wound to the distal humerus with comminuted fracture.
postop dx: same

Name of Procedure: Reduction and application of posterior splint to right distal humeral fracture.

Description of procedure:
At this time, the patient had already received pain medication earlier for injury and at this time, gentle traction was placed on the arm as a posterior splint was placed posterior to the forearm and up to just past the mid-shaft of the humerus. A standard plaster splint was used after appropriate padding and this was held in place and at the end of the procedure radial pulse was palpated and it was 2+ and he had normal sensation in the hand. There were no immediate complications and blood loss.

Okay, I get confused on reduction at bedside. I came up with cpt code 24545 and I’m so not sure. thank in advance

Medical Billing and Coding Forum

Revision open reduction and internal fixation of the medial malleous

Indication : Patient with ankle fracture she underwent ORIF she returned 4 weeks and her hardware was noted to have failure with backing out of screws and gapping of fracture site
Description of procedure : revision of ORIF of the medial malleolus

The overall fracture reduction was felt to somewhat difficult secondary to some additional bone growth secondary to the age of the fracture .This was removed sub periosteal fashion .The claw plate was placed .It was able to have appropriate reduction through the medial clear space. Once the overall reduction was felt to be acceptable , a compression screw was then placed across the fracture site and additional screws were then placed

could you please explain the CPT

Thank you have a great day

Medical Billing and Coding Forum