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fracture care explanation of billing
our office makes every effort to follow the current coding practices for reporting medical services as dictated by the federal government (cms) and the american medical association (ama). these regulation can be quite complicated and generate many questions. the purpose of this handout is to discuss what to expect when we bill for your fracture care.
an insurance claim for fracture care will typically include the following charges:
- an exam for diagnosis and decisions about the best treatment options.
- an x-ray is used to diagnose the fracture. even if you bring x-rays with you, additional views may be required. a post fracture treatment x-ray may be taken to ensure proper alignment has been maintained.
- a fracture code will be assigned based on the site, type of fracture and whether treatment is closed or open. all fracture treatment, whether performed in the office or the hospital, is considered “major surgery” by the cms and ama coding systems. the fracture code will often times be reported as surgery on your insurance company’s explanation of benefits.
- the initial cast application and cast supplies or some type of durable medical equipment will be billed at your initial office visit.
- follow up office visits (exam charges) are included in the fracture code for 90 days after the initial visit. you will only be billed for an exam and fracture code during the first visit. any subsequent x-rays taken will be billed for.
this office is required by the federal compliance laws to report the services provided based on the documentation in the medical records. we cannot improperly alter a claim for the purpose of obtaining payment, nor can we discount patient copays and deductibles. if you discover a billing error, duplicate charge or other posting error, we would greatly appreciate you bring the matter to the attention of our office staff for further investigation and proper corrective action if appropriate.
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