tci ED Coding & Reimbursement Alert - 1999 Issue 10

Reader Question: Correct Fracture Care Code

Question: Can a fracture care code (CPT) for fracture of vertebral traumatic fracture be used with the -52 modifier or would an E/M be more appropriate?Anonymous CA SubscriberAnswer: The selection of the appropriate code for a vertebral fracture would be determined by several key factors: location and type of injury, type of treatment required, amount of care provided and documented by the treating emergency physician, plan of referral to specialist for follow-up treatment, specific payer rules governing surgical package and or specialist billing. The CPT Assistant, Volume 6, Issue 2, 1996, indicates that to bill for orthopedic treatments...

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