Forum - Questions & Answers

May 14th, 2013 - TerryC 39 

fracture care

One of our doctors is charging 27786 for "tx of closed malleolus,simple" all he did was put on a aircast. My procedure book says 27786 "the physician treats a fx without open surgery or and manipulation of the bones". So my question is can he charge this code? It sounds like he can even though he just put on a aircast. It just seems like a lot of money for just putting on a aircast. Thanks

May 14th, 2013 - Orthomom 23 

re: fracture care

[One of our doctors is charging 27786 for "tx of closed malleolus,simple" all he did was put on a aircast. My procedure book says 27786 "the physician treats a fx without open surgery or and manipulation of the bones". So my question is can he charge this code? It sounds like he can even though he just put on a aircast. It just seems like a lot of money for just putting on a aircast. Thanks]

It is appropriate to bill it either with a fracture code and a 90-day global or on an encounter by encounter basis. And, in my experience, the costs to the patient end up being pretty comparable.

The "AAOS Guide to CPT® Coding for Orthopaedic Surgery" states that there are 2 common approaches when coding non-manipulative fracture care services. Both AAOS and the AMA support either approach.
1. Fracture global fees
2. Alternative method for fracture fees

The AAOS definition of fracture global fees reporting method states:

Fracture global fees may include the hospital or office encounter in some payment areas. In others, CMS allows you to code an E/M (E/M stands for “evaluation and management”. E/M coding is the process by which physician-patient encounters are translated into five digit CPT® codes to facilitate billing) service with a -57 modifier [Decision for surgery] within the global period if the visit was the one in which the decision to perform the procedure was made. The initial cast or splint is applied, and all revisits, excluding radiographs that are obtained by the physician, should be included within a 90-day period from the time of the initial fracture. All recastings and or splinting are on an “ encounter” basis and are separately billed.


The AAOS definition of the alternative method is:

"Only when treatment of the fracture does not consist primarily of a “ procedure” (for example, closed treatment without manipulation), services may be itemized as if the problem were recognized as an office encounter. Examples include an undisplaced fracture of the fifth metatarsal; a fracture of the pelvis, undisplaced or minimally displaced; or a compression fracture of a vertebra. Office, hospital, and emergency department encounters are coded as appropriate, as are all injections, supplies, casts, splints or treatment program necessities.

Be aware that this guidance is payer specific: When fracture care is performed in the office, the payer may want you to append modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service to the E/M service.
Your practice must decide whether to bill for treatment of a fracture or to itemize depending on your scenario."

May 15th, 2013 - agent00711   151 

re: fracture care

Per Super Coder: "In this procedure, generally closed hairline fractures are treated which does not require manipulation. Under anesthesia, physician treats the fractured distal fibula (lateral malleolus) with a cast placement. No reduction is done in this process".




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