tci ED Coding & Reimbursement Alert - 2005 Issue 12

READER QUESTIONS: Understand Definitive Care for 21800

Question: The ED physician ordered an x-ray for a patient that revealed broken ribs. He gave the patient pain medication and sent her home. Should we charge for an E/M service and fracture care?Iowa Subscriber Answer: The requirements to bill for fracture care are that the ED physician provided restorative care (moved the bones back into position) or definitive care (the same care a specialist in the field would provide). For rib fractures, definitive care is frequently nonoperative and does not involve splinting or strapping. Instead, this care involves pain control and patient education, in which the physician...

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