Medical Billing for Fractures

When performing medical billing for fractures, it is imperative to know if you are dealing with definitive care or restorative care. Not knowing the difference could cost your physician a lot of money. There are a couple scenarios to keep in mind when deciding if your medical billing should be claimed as definitive or restorative care.

The first step in proper medical coding and medical billing is understanding the nature of definitive fracture care in medical billing. For example: a 33-year old woman is seen in the emergency room for a minor fracture of the radial head. The emergency room physician gives her a sling and a short arm splint. The doctor then states that the patient should keep the splint on for three to four weeks. This would be considered definitive care.

The medical billing staff would report this definitive fracture care with the current procedural terminology code 24650 (Closed treatment of radial head or neck fracture; without manipulation). Since the patient will not receive and did not receive any restorative treatment, 24650 is the correct medical billing code to choose. There will be no follow up for this care, and that is what defines definitive treatment.

The next step is to understand restorative care. For example: a 33-year-old male comes to the emergency room with an angulated mid-shaft fracture of his radius. Blood flow to the head of the radius is decreased. The emergency room doctor not only gives the patient pain medicine, but also reduces the fracture and does a hematoma block. This is called restorative fracture care in medical billing.

The correct medical billing code for this scenario is 25505 (Closed treatment of radial shaft fracture; with manipulation. By performing manipulation on the fracture, the doctor was performing restorative care. Simply put, restorative care helps restore a fracture back to its original state and usually requires follow-up. Your medical billing should always represent the precise type of fracture care that was performed and have medical documentation backing up the procedure will result in the maximum reimbursements on your medical billing claims.

View all Articles by: Melissa Clark, CCS-P