tci ED Coding & Reimbursement Alert - 2006 Issue 11

Break Down Fracture Care Coding Into 4 Simple Steps

Tip: Modifier 54 is a necessity on most fracture claims  When a patient reports to the ED for fracture care treatment, coders will need to be on the lookout for more than just broken bones -- they also need to know if the fracture is open or closed, whether the doctor had to manipulate the injury, and the level of evaluation and management service (E/M) the physician provides in addition to the repair. Without this information, coders run the risk of undercoding their fracture care encounters. Follow these four steps to the proper fracture care code choice: Step 1:...

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