ORTHOPEDICS
William A. Law, MD. * **
Arthroscopy
Shoulder & Knee Surgery
Joseph G. Marsicano, MD.* **
Scoliosis
Spinal Surgery
Joseph P. Bogdan, MD.* **
Adult Joint Reconstruction
Knee Surgery
Bruce Stamos, MD.* **
Sports Medicine
Shoulder & Knee Surgery
Raymond E. Esquieres, MD.*** ****
Physiatry/EMG-NCS
Non-Operative Spine Management
Brian M. Katt, MD.* **
Upper Extremity Surgery
Orthopedic Trauma
David J. Rodricks, MD.* **
Adult Joint Reconstruction
Knee Surgery
Jason A. Nitche, MD. **
Sports Medicine
Shoulder & Knee Surgery
Laura A. Malfitano, DO. *
Hand Surgery
General Orthopedic Surgery
Michael Nakashian, MD
Upper Extremity Surgery
Hand Surgery
Thomas G. Sargent, DO.
Sports Medicine
Non-Operative Musculoskeletal Care
James R. Polowczyk, DPM.
Foot Surgery
Ankle Surgery
Samantha Kanarek, DO***
Physiatry/EMG-NCS
Non-Operative Spine Management
William Gallagher, MD
Sports Medicine
Non-Operative Musculoskeletal Care
Teri L. Nelson, PA-C
Ingrid E. Kaszas, PA-C
Matthew Johnson, PA-C
Leigh Frye, PA-C
Kristen Pirolli, PA-C
Katie Krupke, PA-C
Britta Peters, PA-C
Dineen Connolly, PA-C
*Diplomates of The American
Board of Orthopaedic Surgery
**Fellow American Academy
of Orthopaedic Surgeons
*** Diplomate of The American Board
of Physical Medicine
And Rehabilitation
**** Diplomate of The American Board
Of Pain Medicine
Fracture Care Billing Fact Sheet
If we treat you or your dependant for a fracture, your insurance company requires that we bill our services to you using a national coding system known as CPT (Current Procedural Terminology). The CPT code set is a medical code set maintained by the AMA to communicate uniform information about medical services and procedures between medical providers and insurance companies. The codes used to describe the services we completed for you (or your dependant) are found in the “surgery” section of the CPT codebook. This does not mean that you had an operation. This is merely the way the CPT codebook is organized for use by both insurance companies and physicians.
According to the CPT guidelines, fracture care is billed as a “packaged” service. This means that at the time of initial care, a bill is generated that includes:
1. Evaluation and treatment of a fracture
2. The first cast or splint application
3. 90 days of normal, uncomplicated, follow up care
The procedures and other items NOT INCLUDED in the package are:
1. X-rays
2. Any replacement cast application
3. Durable Medical Equipment (crutches, brace, boot, etc.)
3. The evaluation and management of any additional problems or injuries
4. The treatment of complications
There will be a separate charge for these services.
Your insurance company may cover the care rendered for fractures differently than for office visits. Therefore, when you receive the explanation of insurance benefits, the services may be paid as a surgical procedure with deductible and co-insurance guidelines applied. We are using the most appropriate code available to describe the care rendered. We are required legally to use this code to bill for this service. As always, we encourage you to check with your insurance company and verify the benefits available.
If you have any questions regarding the fracture care fees, please do not hesitate to call our billing office at (732) 840-7500.