Outpatient Facility Coding Alert - 2017 Issue 12
E/M Services: Nail Down the Rules for Coding E/M Codes With Fractures
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Article Overview
This article explains how separate evaluation and management services may be reported when fracture care is provided, and why the answer can vary by payer and contract. It is aimed at coders, billers, and compliance staff who work with emergency department, orthopedic, and physician claims and need to understand payer-specific guidance, global period concepts, and modifier use.
Why This Topic Matters
Fracture-related encounters can involve both an evaluation and a procedure, and the correct reporting approach may differ across payers and contracts. Understanding the article helps coding professionals identify when payer policy may affect claim submission and review.
Article Sections
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Observe Payer Specificities on Fracture Care E/Ms
This section introduces payer variation in reporting evaluation and management services associated with fracture care. It frames the discussion around global periods, separate services, and policy differences across insurers.
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Payers Muddy Modifier Waters With 25 Decision
This section continues the discussion of payer-specific modifier treatment for fracture-related encounters. It highlights that requirements can differ among Medicare contractors and other payers, and emphasizes checking contract terms.
What You Will Learn
- How payer policies can affect reporting of evaluation and management services with fracture care
- Why global period concepts are central to this topic
- How modifier selection may vary across insurers and contracts
- Which kinds of claim situations require closer review before submission
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Emergency department coding staff
- Orthopedic coding staff
Modifiers Discussed
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