Sunday, February 27, 2011

Understanding CPT Code 28510 - Billing for Fracture Care Follow-Ups

Standard Fracture Care

When a patient suffers from a fracture, the initial treatment of the injury is usually performed in the emergency room. If your patient comes to your office for their fracture follow-up care instead of seeing an orthopedic specialist, you can bill for the follow-up care as long as you use the appropriate procedure codes and the ICD-9 code that correlates with the site of the fracture. CPT code 28510 covers the follow-up care for all closed fracture sites except for a fracture that is located in the big toe. Because of this, you will not need to perform any site manipulations to bill for the follow-up care you provide to your patients. Using CPT code 28510, you can expect to receive more than $100.00 for each follow-up visit related to the fracture.

Identifying the Correct Modifier

When treating a patient for follow-up fracture care, it is not uncommon to spend significant amounts of time addressing the injury. It is also common for patients to address other ailments during the course of their follow-up visits to your office. Fortunately, you can bill for the time spent addressing these ailments separately from the follow-up fracture care. Because you are addressing issues that are separate from the fracture itself, by documenting the visit accurately, you can bill for the separate consultation in addition to the fracture follow-up.

Fracture care has a specified global period in regards to medical billing. In order to bill correctly, your diagnosis codes must match each procedure performed. You should also take care to use the appropriate modifier for the office visit code when treating your patients. This will help you in your billing procedures.

It is important to remember that there will be times when a patient suffers from multiple fractures at different sites. For example, a patient who has suffered a serious accident may face broken ribs in addition to broken bones in the arm or leg. In cases such as this, you should bill for each site separately and use the appropriate modifier to separate the treatment of each fracture site. Also make sure that you document how much time is spent addressing each fracture site when treating your patient. In some cases, you may only be able to treat one fracture at a time when dealing with patients who are suffering from multiple injuries.

Understanding Worker's Compensation & PIP Guidelines

Many of the injured patients you treat will be billed through primary insurance providers, however, other patients may suffer injuries due to work-related activities or car accidents. Because of this, you need to ensure that you thoroughly understand the guidelines and regulations pertaining to Worker's Compensation and Personal Injury Protection policies in your state.

Depending on the area of your practice, the insurance carriers you bill may not accept modifiers or they may require that you use modifiers that are different from the ones you would normally use. The goal is to be paid for your time regardless of the type of insurance you are submitting claims to. If the insurance provider does deny a claim for the initial fracture care, you will need to call and explain to the provider that you did not provide the initial fracture care to the patient.

Obtaining the Compensation You Deserve

You can expect to treat at least ten patients a year for follow-up care related to a fracture. If these patients come to your office for treatment of a single-site fracture, each patient you treat will generate over $500.00 in billable revenue in addition to the revenue received for the standard office visit. It is not uncommon for practices to receive thousands of dollars in extra revenue each year for the treatment of fracture follow-up care, even if there are only a few patients in their care receiving this treatment. Because of this, you should do everything you can to take advantage of this particular source of revenue whenever possible.


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