Fracture Care: Manipulation versus Non-Manipulation

See to it that you take advantage of manipulation opportunity when your orthopedist performs fracture care or you could be losing out on your payments without the right manipulation knowledge.

For instance the orthopedist carries out closed treatment on a fractured fibula; if she uses manipulation, the service is worth about $119 more than a non-manipulation encounter. But then you should consider various factors before you decide a manipulation warrants the treatment. Equip yourself with these three tips to get you started.

Know what you are dealing with If you have no idea what manipulation is, you cannot support your claim. Manipulation involves reduction or attempted reduction of the fracture or dislocation. Orthopedists would normally perform a ‘closed’ manipulation, which takes place when the physician is repositioning or relocating a displaced closed fracture back to the correct anatomical position without opening it surgically. Nevertheless, there is such a thing as ‘open’ manipulation. Payout: From the previous example of closed treatment on a fractured fibula, you’d think about two CPT codes to report the treatment: 27780 and 27781. CPT 27780 pays about $272.49, while 27781, with 10.61 RVUs, pays about $391.22. Key words give away manipulation procedure If you depend on physician’s notes to give evidence of manipulation, you have a chance of being misled. Here’s why: The word ‘manipulation’ doesn’t make its way into physician encounter notes very often. Normally, what you should look for is the term ‘closed reduction’, which is used for non-operative treatment of fractures that are treated without surgery. Other terms that might help identify a manipulation procedure include ‘reduce’, ‘align’ and ‘reset’. Spot manipulation evidence in these examples You will be able to distinguish a manipulative treatment from a non-manipulative one only when you learn to read your physician’s notes between the lines. An instance of manipulative care. Example 1: A 20-year-old patient injured himself when an opponent in a football game tackled him. The doctor documents a level-three E/M, which includes a foot X-ray the physician diagnoses a distal interphalangeal joint dislocation (DIPJ) of the toe. The physician notes that he reduced and reset toe. An instance of non-manipulative care. Example 2: A 16-year-old new male patient reports to the orthopedist with an injured left toe, which happened during a tackle football game. The doctor documents a level-two E/M with an X-ray and pain meds. After reviewing the X-ray the doctor diagnoses a proximal phalanx fracture on the foot, which he wraps in a splint. The encounter notes read ‘non-displaced fracture splinted in good position. Treatment with NSAIDS for pain.” For more medical coding guide visit site like Supercoder.