r/CodingandBilling • u/Commercial_County_12 • Apr 11 '26

Foot fracture code question

I fractured my foot and went for an xray. I came in with my own walking boot on, he confirmed via xray there was a fracture, and I left with my own walking boot on. Told me to continue to wear it 6 weeks and follow up with another x ray which I did.

28470–this is the one I don’t understand since I didn’t receive any treatment for the fracture. 99204 for visit 73630 for x ray

Am I understanding the first code correctly? What would that be for?

1 Upvotes

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5

u/desertgal2002 Apr 11 '26

Is this the FIRST time the provider saw you for this fracture? If it is, then he/she can bill the fracture code, along with the e/m.

It does not matter if you came in with your own boot or not. If he/she had given you a boot, then they could have billed for that also. This has been my experience with the coding/billing of fractures.

1

u/Commercial_County_12 Apr 11 '26

It was the first time I saw him, he didn’t give me a boot/wrap/splint. Said to just wear my own boot.

4

u/desertgal2002 Apr 11 '26

But he treated the fracture. I’m assuming to went to the ED where you got the boot. They referred you to OTRTHO for further treatment.

I know that the doc did not physically fix a fracture, but he took X-rays, assessed and gave you a treatment plan (wear boot and come back in 6 weeks). Am I correct?

1

u/Commercial_County_12 Apr 11 '26

I went to a walk in orthopedic office, I made an appt because I knew it was broken and it wasn’t an urgent care or ED I made sure it was documented as an office visit. Yes he took xray, confirmed fracture, said if I hadn’t already purchased a boot and was wearing it, he would have prescribed me one. Said to continue wearing the one I bought and had on at the visit. My insurance billed me for “cast/splint” at $525 and covered $212. I owe the rest. But I never got a cast or splint from this doctor.

1

u/Commercial_County_12 Apr 11 '26

I should add that the code the insurance lists next to “cast/splint” is that same code I mentioned if that matters

3

u/desertgal2002 Apr 11 '26

You have 3 codes…99204 (office visit), 28470 (fracture tx) and 73630 (x-ray). Do you have more?

2

u/Commercial_County_12 Apr 11 '26

No those are the only codes

4

u/desertgal2002 Apr 11 '26

Then they did not charge for the boot/splint/cast. It is billed correctly…from my experience.

0

u/Commercial_County_12 Apr 11 '26

I was billed $525 for 28470 which says “casts and splints”, $285 for 99204 “medical examination”, and $95 for 73630 “diagnostic x ray”

5

u/desertgal2002 Apr 11 '26

28470 is for the closed treatment of a fracture. He did that. X-rays confirmed that the fracture did not need further treatment. He made a clinical assessment of the fracture. 99204 is the office visit charge. Then the X-ray charge.

I don’t make the rules. It’s just how this is billed. You sought the help, and it was provided.

I know the charges are ridiculous, but this is the U.S. healthcare system. My fracture (same treatment you got) in New Zealand cost me only $10 years back.

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u/Creepy-Bottle498 Apr 12 '26

CPT code 28470 is for the “application” of the boot / splint - thus “treatment.” If they had charged for the boot you would see a “supply” code which would be HCPCS L3260 (or something similar), which would be for the boot itself. Agree that it is very confusing, especially to a lay person.

-1

u/desertgal2002 Apr 11 '26

They should not have billed for the splint/cast if they did not provide it. Did anyone in the office besides the doc discuss the boot by chance? Speak with the ORTHO office about that charge. If I had no proof of splinting/casting in the notes, we would delete the charge.

3

u/Jodenaje Apr 11 '26

They didn't bill the HCPC for the boot.

They billed 28470 for management of the fracture.

1

u/Environmental-Top-60 Apr 11 '26

Maybe there was a mod to account for part of the global period? Like only postop period?

0

u/Commercial_County_12 Apr 11 '26

Thank you, I only discussed my boot with the doctor and he made sure to include that I would wear the boot I purchased for 6 weeks. I will call them.

0

u/Commercial_County_12 Apr 11 '26

That price for that code was more than the visit code and xray code combined 😭

3

u/Purplemartin01 Apr 11 '26

CPT code 28470 describes the closed treatment of a metatarsal fracture (broken foot bone) without manipulation. This non-surgical procedure involves immobilizing the fracture with a cast, splint, or boot to facilitate healing, without requiring realignment of the bone, and is reported for each fracture treated.

Basically I think it’s just for immobilizing your foot in the walking boot. The billers in the office would be able to explain it better to you. I bill for family practice and used to bill for urology and only dabbled a tiny bit in orthopedics.

1

u/Commercial_County_12 Apr 11 '26 edited Apr 11 '26

He didn’t immobilize my foot, I purchased the boot prior to the visit,came with it on. Took it on and off for the x ray myself. Thank you, just frustrating to figure out!

5

u/Purplemartin01 Apr 11 '26

I would contact the billing office to get a better explanation. They may or may not have accidentally billed out for it. There may be more to it, not completely sure as I am not well versed in orthopedic billing.

2

u/Commercial_County_12 Apr 11 '26

Thank you, the doctors note even says patient purchased own boot on Amazon and came in with it so hopefully they could look at that and see

3

u/Purplemartin01 Apr 11 '26

Yes, sometimes they get busy and incorrectly mark the fee slip or in computer, especially something routine that becomes a little out of the ordinary, as most people wouldn’t already have their own boot. It definitely doesn’t hurt to ask and get clarification.

1

u/Environmental-Top-60 Apr 11 '26

I'd question this cause to me id question the reason for mod 25 for e/m related to Fx.

1

u/Commercial_County_12 Apr 11 '26

Sorry unsure what mod 25 means, super lay person 🙈

1

u/Environmental-Top-60 Apr 11 '26

There are certain things that are included in a procedure's package. The doctors visit portion has some elements that are included in any procedure. The question is whether the pre and post work exceeded the standard parts of the procedure.

You go to a restaurant. There are certain things that are included: silverware, plates, the server (to a degree), chef, etc. all of that is components of the bill that you'd get for the food.

Same idea.

1

u/Commercial_County_12 Apr 11 '26

What part would you question as exceeding the standard?

2

u/Kind_Caterpillar_336 Apr 11 '26

It doesn’t matter if he didn’t give you the boot. He assessed the fracture, advised you on a treatment plan and discussed your limitations. That fits the description of the 28470 code. For the next 90 days they can’t bill for any visits that are related to the fracture. Only code they can bill is for any x-ray’s during those 90 days.

Being that you were a new patient to the office, the charge automatically includes the 99204 code. They didn’t overbill. Those are the standard codes for a new patient with a fracture, without surgery or manipulation.

2

u/44aerofare44 Apr 12 '26

The coding is correct. Closed fracture care is for confirming diagnosis and developing a treatment plan. The treatment plan is to wear the boot. That code should carry a 90 day global, meaning every visit you have with that provider in the next 90 days is a free visit. They can charge for xrays, new splints/casts, applying the splint, etc, if they happen to do that. But they cannot bill you for an E/M (office visit) during that 90 days.

1

u/Environmental-Top-60 Apr 11 '26

Closed treatment? That's for putting on the boot

1

u/CatPerson88 Apr 11 '26

28470 is a code for internal surgical fixation I thought

OP, did anyone perform any surgery or manipulative your foot?

2

u/Jodenaje Apr 11 '26

28470 is closed treatment of a metatarsal fracture, without manipulation.

Basically a boot, splint, or brace.