Of the different fracture treatment methods such as closed reduction and percutaneous fixation an orthopedic physician provides, closed treatment without manipulation involves fitting the patient to appropriate materials for bone stabilization and weight bearing/non-weight bearing function. This fracture treatment without manipulation is commonly provided by orthopedic surgeons at many different sites of service – inpatient, outpatient, office, or emergency department [ED]. Typically, orthopedic surgeons provide follow-up care until fracture healing has occurred and function has been restored. As the coding and documentation for closed treatment of fractures is nuanced and complex, most orthopedic practices and EDs rely on medical coding outsourcing to meet their requirements.
All closed fracture treatment, without manipulation is considered “major surgery” by Federal and AMA coding systems, and is reported as surgery when billed. Therefore, on the insurance Explanation of Benefits it may reflect “surgery”. However, for billing and insurance coding purposes, caring for a fracture without manipulation (movement), surgery and without anesthesia, is called “fracture care”.
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CPT Codes for Non-Operative, Fracture Care without Manipulation
- 22310 – Under Fracture and/or Dislocation Procedures on the Spine (Vertebral Column)
- 23500 – Closed treatment of clavicular fracture
- 23570 – Closed treatment of scapular fracture
- 23600 – Closed treatment of proximal humeral (surgical or anatomical neck) fracture
- 23620 – Closed treatment of greater humeral tuberosity fracture
- 24500 – Closed treatment of humeral shaft fracture
- 24530 – Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension
- 24560 – Closed treatment of humeral epicondylar fracture, medial or lateral
- 24576 – Closed treatment of humeral condylar fracture, medial or lateral
- 24650 – Closed treatment of radial head or neck fracture
- 24670 – Closed treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process)
- 25500 – Closed treatment of radial shaft fracture
- 25530 – Closed treatment of ulnar shaft fracture
- 25560 – Closed treatment of radial and ulnar shaft fractures
- 25600 – Closed treatment of distal radial fracture (Colles or Smith type)
- 25622 – Closed treatment of carpal scaphoid (navicular) fracture
- 25630 – Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular])
- 25650 – Fracture and/or Dislocation Procedures on the Forearm and Wrist
- 26600 – Closed treatment of metacarpal fracture, single
- 26720 – Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb
- 26740 – Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint
- 26750 – Closed treatment of distal phalangeal fracture, finger or thumb
- 27197 – Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation
- 27220- Closed treatment of acetabulum (hip socket) fracture(s)
- 27230 – Closed treatment of femoral fracture, proximal end, neck
- 27238 – Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture
- 27246 – Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint
- 27267 – Closed treatment of femoral fracture, proximal end, head
- 27500 – Fracture and/or Dislocation Procedures on the Femur (Thigh Region) and Knee Joint
- 27501- Fracture and/or Dislocation Procedures on the Femur (Thigh Region) and Knee Joint
- 27508 – Fracture and/or Dislocation Procedures on the Femur (Thigh Region) and Knee Joint
- 27516 – Closed treatment of distal femoral epiphyseal separation
- 27520 – Fracture and/or Dislocation Procedures on the Femur (Thigh Region) and Knee Joint
- 27530 – Closed treatment of tibial fracture, proximal (plateau)
- 27750 – Closed treatment of tibial shaft fracture (with or without fibular fracture)
- 27760 – Closed treatment of medial malleolus fracture
- 27767 – Closed treatment of posterior malleolus fracture
- 27780 – Closed treatment of proximal fibula or shaft fracture
- 27786 – Closed treatment of distal fibular fracture (lateral malleolus)
- 27808 – Closed treatment of bimalleolar ankle fracture
- 27816 – Closed treatment of trimalleolar ankle fracture
- 27824 – Closed treatment of fracture of weight bearing articular portion of distal tibia (pilon or tibial plafond), with or without anesthesia
- 28400 – Closed treatment of calcaneal fracture
- 28430 – Closed treatment of talus fracture
- 28450 – Treatment of tarsal bone fracture (except talus and calcaneus)
- 28470 – Closed treatment of metatarsal fracture
- 28490 – Closed treatment of fracture great toe, phalanx or phalanges
- 28510 – Closed treatment of fracture, phalanx or phalanges, other than great toe
Acceptable documentation for reporting non-surgical/non-manipulative fracture care includes buddy tape for muscular fracture in fingers, toes, immobilizer for knee (L1830), sling for elbow (24670), shoulder (23520, 23540, 23570), and swath (w/sling) for humeral shaft (24500), unacceptable, nonspecific documentation includes gait/balance training, home exercise program, physical therapy and non-weight bearing (NWB) with no elaboration.
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Fracture Coding Rules
In its recent article, AAPC has discussed certain ground rules for both operative and non-operative fracture care coding. Based on these rules,
- Initial fittings of casts, splints, strappings, and other materials are included in the global service of fracture care.
- A subsequent fitting or refitting can be reported with modifier 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period appended to the CPT© code.
- When fracture care is provided in the doctor’s office (POS 11 Office), materials may be reported separately with an appropriate HCPCS Level II code. The payer determines whether the supply will be paid.
- In a hospital setting, the facility bills for fracture stabilizing materials.
- A fracture not indicated as open (or implied by the presence of a skin wound) is considered closed and a fracture not indicated as non-displaced is considered displaced.
- Additional intra-operative services may be bundled into fracture surgeries, such as debridement, bone grafts, or old hardware removal.
- If an E/M service is provided on the same day as fracture care (which usually is the case), modifier 57 Decision for surgery must be appended to the E/M code.
- Follow-up visits within the global period can be tracked using 99024 Postoperative follow-up visit, normally included in the surgical package.
In orthopedic medical coding, as the CPT© codes for closed fracture treatment without manipulation represent retainer fees on behalf of the physician with regard to patient care, the cost for this treatment can be high. Physicians must explain the patients that the fee covers not only the material like splint, but also, the follow-up examinations over a 90-day period along with the cost of the splint.
In serious cases such as an elderly patient falling and sustaining a hip fracture, bed rest, pain control, non-weight bearing instructions, and potentially imminent surgical preparations may be in order. Also, for critically ill patients where no treatment is given other than pain control for palliative care, physicians can check with the patient’s payer to see what their guidelines are for reporting closed treatment for the type and location of the patient’s fracture.
Fracture care coding in an orthopedic practice is usually a high volume service. Medical billing and coding companies with experience in providing documentation for this specialty can assist physicians with their quality services.