Decoding Billing Codes for Different Fracture Repair Procedures

The Complex World of Orthopedic Billing

From managing hectic schedules to navigating complex orthopedic coding guidelines, you often struggle to maintain a balance between the two. What if, despite providing top-notch fracture care, your claims are denied due to coding errors?

The frustration can be overwhelming. But there is a solution that can resolve this problem: mastering billing codes for different fracture repair procedures.

Did you know that orthopedic physicians experience one of the highest claim denial rates (18%) in healthcare? This statistic, reported by MedScape’s “Physician Compensation Report 2020”, highlights the critical need for precise and compliant coding practices.

In this article, we will understand the vital fracture repair billing codes and offer a top-notch solution that can be a game-changer for your practice.

Why Accurate Fracture Care Coding Matters?

Fracture care coding involves a thorough understanding of relevant CPT codes and strict adherence to coding guidelines. Accurate use of CPT codes for fracture care is vital for ensuring appropriate reimbursement and maintaining compliance with healthcare regulations. This precision is fundamental to avoid claim denials and maintain the financial integrity of your practice.
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Common Fracture Care Treatment Methods and CPT Codes

Fracture care coding includes various treatment methods, each with specific CPT codes. Here are some of the most common:

1. Closed Treatment Without Manipulation:

Typically used for simple fractures that don't require surgery. This method focuses on stabilization, often with casts or splints.

Common CPT Codes:

  • 21310 – Closed treatment of a nasal bone fracture without manipulation.
  • 28510 – Closed treatment of a metatarsal fracture without manipulation.
  • 25600 – Closed treatment of a distal radial fracture without manipulation.

2. Closed Treatment with Manipulation:

Involves realigning the bone without surgical intervention.

Common CPT Codes:

  • 25605 – Closed treatment of a distal radial fracture with manipulation.
  • 28470 – Closed treatment of a metatarsal fracture with manipulation.
  • 21315 – Closed treatment of a nasal bone fracture with manipulation.

3. Open Reduction with Internal Fixation (ORIF):

A surgical procedure to fix severe bone fractures.

Common CPT Codes:

  • 25607 – Open treatment of a distal radial fracture with internal fixation.
  • 27236 – Open treatment of a femoral fracture with internal fixation.
  • 24546 – Open treatment of a humeral shaft fracture with internal fixation.

4. Percutaneous Fixation:

Minimally invasive surgical technique using small incisions and instruments.

Common CPT Codes:

  • 25606 – Percutaneous skeletal fixation of a distal radial fracture.
  • 27235 – Percutaneous skeletal fixation of a femoral fracture.
  • 27756 – Percutaneous skeletal fixation of a tibial fracture.

3 Tips for Accurate Coding

1. Avoid Unspecified Codes: Detailed documentation is crucial to avoid rejections.
2. Document Encounter Types: Correctly identify initial, subsequent, or sequela encounters.
3. Follow-Up Details: Ensure all follow-up care and healing statuses are documented.
Orthopedic practitioners have demanding schedules, and mastering complex coding guidelines is time-consuming. Moreover, keeping up with annual updates to ICD-10-CM guidelines and CPT codes adds another layer of complexity.

The Solution: Delegating Orthopedic Billing Operations to Experts

Outsourcing your coding services to experts, such as Medical Billers and Coders (MBC), can significantly enhance your practice's efficiency and revenue cycle management.

Benefits of Outsourcing Orthopedic Billing and Coding

  • Expertise and Accuracy: Specialized billing companies like MBC have in-depth knowledge of orthopedic coding, ensuring high accuracy and compliance.
  • Cost Efficiency: Outsourcing can lead to noticeable cost savings and a 10-15% increase in revenue.
  • Streamlined Claims: MBC's expertise helps maximize revenue generation through clean claims and optimized reimbursements.
  • Focus on Patient Care: By delegating billing tasks, you can focus more on patient care and less on administrative burdens.

Partner with Medical Billers and Coders (MBC):

Ready to streamline billing processes and ensure compliance with ease? Look no further than MBC. From advanced practice management solutions to expert guidance on compliance matters, we have got you covered. Our team of experts is here to support your orthopedic practice every step of the way.
Contact MBC today to get complete reimbursement for your fracture repair procedures and achieve financial stability. Call us at: 888-357-3226 or email us at:


Q: What are the common causes of claim denials in orthopedic billing?

A: Common causes of claim denials in orthopedic billing include coding errors, lack of documentation detail, and using unspecified codes. Ensuring precise and detailed documentation can significantly reduce denial rates.

Q: Why is it crucial to avoid unspecified codes in fracture care billing?

A: Unspecified codes can lead to claim denials as payers require detailed information for reimbursement. Detailed documentation ensures compliance and reduces the risk of denials.

Q: Where can I find reputable sources for orthopedic billing and coding guidelines?

A: Reputable sources for orthopedic billing and coding guidelines include the American Academy of Orthopaedic Surgeons (AAOS)  and Centers for Medicare and Medicaid Services (CMS).

Q: How can I improve my fracture care coding accuracy?

A: Regular training, staying updated with coding guidelines, and possibly outsourcing to experts like MBC can improve accuracy and compliance.

Published By - Medical Billers and Coders
Published Date - Jul-11-2024 Back

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