Coding Practices Affect the Cost of Distal Radius Fracture Care

The purpose of this study was to determine the impact of an Emergency Medicine Department’s billing practices on the total cost of care for distal radius fractures.

This study identified patients by International Classification of Diseases, Ninth Revision (ICD-9) billing codes treated by the Department of Orthopaedic Surgery (DOS) and Department of Emergency Medicine (DEM) at the University of Arizona. In every case, the surgical modifier 54 was used. The billing records in each case for the DEM and the DOS were reviewed.

When the fracture was manipulated and the DEM was the attending of record for the initial visit, the total cost of fracture care was increased by $500. When the fracture was not manipulated, the total cost of fracture care was increased by $270. Although more than one-third of patients had surgery by the DOS, the DEM used a global billing code that indicates “restorative” treatment.

This is an example of the manipulation of Current Procedural Terminology coding to enhance revenue generation with increased cost to the healthcare system, and no added value to outcome.

To listen to William A. Grana, MD, MPH, discuss the clinical significance of this study, click here.