Billing and Coding: Fracture Care

Surgeons who do not provide postoperative follow-up during the 90-day global period should bill the procedure with modifier 54 while the physician providing postoperative management bills with modifier 55; split postoperative care must be documented (date ranges) on the CMS-1500 (item 19). Append modifier 57 to E/M codes when the decision for surgery occurs the day before or day of surgery, and append modifier 24 for postoperative visits unrelated to the procedure; use the specified Level II Q-codes for cast/splint supplies (additional payment), and do not bill cast removal/repair codes (29700-29750) separately if the same physician or same group applied the cast.

"When the operating surgeon does not provide any postoperative follow-up care during the 90-day global period, the surgeon should bill the procedure with modifier 54 to indicate reduced services."

Sign up to see full coverage criteria, indications, and limitations.