In order to maximize billing when caring for patients with fractures two things should be done:
The physician does not need to place the splint, but the physican must document that they checked the splint for proper placement and alignment for it to be billed appropriately..
Emergency physicians also provide a lot of "definitive" care for fractures. (i.e.: we provide the same care that the treating specialist would provide) and can bill for a higher level if this is documented properly.
For instance, if you are treating a impacted, stable distal radius fracture with a splint and pain medication this is the same definitive care the orthopedist would do as they are only going to exchange your splint for a cast.
Another example is the treatment of rib fractures which may consist only of pain control, incentive spirometry and instructions to prevent pneumonia.
In these patients, have the patients follow up more than 48 hours later. If you document that the patient will followup in less than 48 hours, most auditors and billing companies will assume you are not providing definitive care and will not code for the higher earning RVU.
Finally, you should obtain post-reduction x-rays on any fracture that you manipulate and document that the patient is neurovascularly intact prior to discharge.
