Fracture care codes include initial treatment (closed or open reduction) bundled with a 90-day global period. Common codes: 27236 (hip fracture), 25600 (distal radius), 27530 (tibial fracture). The 90-day global period covers preoperative, operative, and postoperative care; do not bill separate E/M during this window. Use modifier 24 only when E/M addresses an unrelated problem. X-ray interpretation billed separately with modifier 26 (professional component). Prior authorization may be required by payers for operative treatment.
Select code based on fracture site, type (simple, comminuted), and treatment method (closed reduction, open reduction, percutaneous fixation). Code description specifies treatment method. The 90-day global period bundles all care related to the fracture treatment. Do not bill E/M visits for fracture-related care during 90 days unless using modifier 24 for an unrelated condition. X-ray professional interpretation is billed separately; technical component is facility responsibility. Document fracture site, type, and specific treatment rendered.
Most commercial payers require prior authorization for surgical fracture treatment. Authorization typically covers operative treatment plus 90 days of postoperative care. Some payers limit follow-up imaging within specified timeframes. Workers compensation programs cover all medically necessary fracture treatment. Medicare covers fracture treatment without session limits. Verify payer-specific authorization requirements and coverage limits before treatment planning.
Modifier 24 (unrelated E/M) is used only when billing E/M during the 90-day global period for a condition completely unrelated to the fracture treatment. Document clearly that the E/M visit addresses an unrelated problem. Modifier 26 applies to X-ray professional interpretation. Do not use modifier 25 for fracture codes. Modifier 59 is not typically used for fracture-related services.
Document fracture location (anatomic site, laterality), type (simple, comminuted, pathologic), and any associated injuries. Describe treatment method (closed reduction, open reduction, internal fixation, external fixation). Include preoperative assessment, operative findings, and immediate postoperative status. For follow-up visits during global period: document healing progress, imaging results, and functional status. If E/M billed with modifier 24, clearly document the unrelated condition addressed.
The 90-day period includes preoperative evaluation, the procedure, and all postoperative care. Do not bill separate E/M during this period unless it addresses an unrelated problem with modifier 24.
Use modifier 24 on E/M codes during the 90-day global period if the visit addresses a condition unrelated to fracture treatment.
Yes. X-ray interpretation billed with modifier 26 (professional component) unless facility billing applies. Includes clinical judgment about fracture type and severity.
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