General Surgery Coding Alert - 2017 Issue 12
E/M Coding: Know These E/M Rules to Avoid Fracture Care Fails
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Article Overview
This article explains general considerations for reporting evaluation and management services that occur before fracture care, with emphasis on payer-specific variation and differing approaches among insurers and Medicare contractors. It is written for coders, billers, and reimbursement staff who need to understand how global periods, payer policies, and modifier usage affect claim reporting for orthopedic and fracture-related services.
Why This Topic Matters
Preoperative E/M reporting around fracture care can be billed differently depending on the payer and the global period attached to the procedure. Understanding the article helps coding staff recognize when payer contracts and local rules may affect claim submission.
Article Sections
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Observe Payer Specificities on Fracture Care E/Ms
This section discusses general payer variation in reporting evaluation and management services before fracture care and references the role of global periods in determining reporting approaches.
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Payers Muddy Modifier Waters With 25 Decision
This section outlines how reporting expectations may differ among Medicare contractors and other payers when E/M services occur before fracture-related procedures.
What You Will Learn
- How payer policy can affect reporting of evaluation and management services before fracture care
- Why global periods are relevant to pre-service E/M reporting
- How modifier selection may vary across insurers and Medicare contractors
- Why contract review matters before submitting claims involving fracture care and separate E/M services
Who Should Read This
- Medical coders
- Billing staff
- Compliance personnel
- Orthopedic practice administrators
- Revenue cycle professionals
Modifiers Discussed
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