Despite the fact that many emergency department physicians provide fracture care on a regular basis, a myth that it is not permissible to bill for this type of care has slowly spread through the medical community. While this rumor is certainly false, it is important to note that there are distinct guidelines to follow when reporting definitive and restorative care, the two different types of fracture treatment.
The first type of fracture treatment is called restorative care, and it refers to the provider actually manipulating the damaged bone in order to realign it for proper healing. This type of care works best for several kinds of common fractures, including those of the fingers, toes, metacarpals, fibulae, and radii, as well as both bimalleolar and trimalleolar ankle fractures. For example, if a patient presents with a distal radial fracture and the provider uses manual manipulation to set the injury, then it should be coded with CPT code 25605 (Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation).
The other major type of fracture treatment is called definitive care, which refers to a provider treating the injury with a splint or other orthopedic care without performing manipulation. While this type of care also applies to fingers and toes, it also works well for fractures of bones that are harder to reach, such as the clavicle. This is the more common type of fracture care provided in the emergency department, and it covers basic treatment such as administering pain medication, applying a splint or medical tape to stabilize the injury, and explaining the plan of care. A common example of this code is 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each).
Regardless of which type of care is provided, they are both eligible for reimbursement even in the emergency department, so coders and billers should be sure to check the claim carefully in order to receive proper payment.