Back and Flank coding

According to CPT guidelines, fracture care is billed as a “packaged or global” service. This means that at the time of initial care, a bill is generated that includes:  1) The first cast or splint application. 2) Usually 90 days of normal, uncomplicated follow-up care. (This may vary with different insurance companies/policies). What is not included in the package. (There

will be a separate charge): 1) Physician evaluation of the fracture. 2) X-rays. 3) All casting supplies (fiberglass, Gortex, ace wraps, slings, cast shoes, etc). 4) Any replacement cast application. 5) The evaluation and management of any additional problems or injuries. 6) The treatment of complications

The following table lists Fracture and/or Dislocation codes in the main subsection headings of the Musculoskeletal System section

Manipulation is used throughout the musculoskeletal fracture and dislocation subsections to specifically mean the attempted reduction or restoration of a fracture or joint dislocation to its normal anatomic alignment by the application of manually applied forces

Open Reduction Internal Fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or setting, of the bone itself. Open reduction refers to open surgery to set bones, as is necessary for some fractures. Internal fixation refers to fixation of screws and/or plates, intramedullary bone nails (femur, tibia, humerus) to enable or facilitate healing. Rigid fixation prevents micro-motion across lines of fracture to enable healing and prevent infection, which happens when implants such as plates (e.g. dynamic compression plate) are used. Open Reduction Internal Fixation techniques are often used in cases involving serious fractures such as comminuted or displaced fractures or in cases where the bone would otherwise not heal correctly with casting or splinting alone. Risks and complications can include bacterial colonization of the bone, infection, stiffness and loss of range of motion, non-union, malunion, damage to the muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates, screws, and pins, compartment syndrome, deformity, audible popping and snapping, and possible future surgeries to remove the hardware.

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