Podiatry Coding: Manipulative Fracture Care Has A $100 Profit Edge Over Non-manipulative

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You podiatrist carries out fracture care. In doing so, see to it that you take advantage of manipulation opportunity or you could be losing out on your payments without the proper manipulation know how.

Say for instance your podiatrist carries out closed treatment on a fractured fibula; if she makes use of manipulation, the service is worth about $119 more than a non-manipulation encounter. But then you should take into consideration various factors. Here are three tips to help you get a kick start:



What are you dealing with?

You should know what you are dealing with. You cannot support your claim if you have no idea what manipulation is. It involves reduction or attempted reduction of the fracture or dislocation.

Normally, a podiatrist carries out a 'closed' manipulation, which takes place when the doctor is repositioning or relocating a displaced closed fracture back to the proper anatomical position without surgically opening it. In the same way, there's such a thing as 'open' manipulation.

Manipulation procedure
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You may land in trouble if you rely on physician's notes to give evidence of manipulation.

Here's why: The word 'manipulation' doesn't make its way into physician encounter notes frequently.

Normally, you should look for the term 'closed reduction', which is used for non-operative treatment of fractures that are treated minus surgery. Some of the other terms that might help identify a manipulation procedure include 'reduce,' 'align,' and 'reset.'

Spot manipulation

You will be able to read differentiate between a manipulative treatment from a nonmanipulative one only when you learn to read your physician's notes. Here are two instances to help your understanding.

First instance: A 20 year old just in patient reports to the podiatrist with an injured right toe. The injury took place when he was tackled by an opponent in a football game. The doctor documents a level-three evaluation and management, which includes a foot X-ray and administration of pain medication. Post the X-ray review, the doctor diagnoses a displaced fracture of the distal phalanx. The doctor notes that he reduced and reset toe at distal end. Post this he places the toe in a splint. This is an instance of manipulative care. You'd report the following on the claim: 99202, 28515, 826.0, E007.0.

Second instance:


A 16-year old male just in patient reports to the podiatrist with an injured left toe, which took place during a football game. The doctor documents a level-II E/M with an X-ray and pain meds. Soon after reviewing the X-ray the doctor diagnoses a proximal phalanx fracture on the foot, which he wraps in a splint. According to the encounter notes, read 'non-displaced fracture splinted in good position. Treatment with NSAIDS for pain." This on the other hand is an instance of non-manipulative care. You should code the following on the claim: 99202-57 for the E/M, 28510 (… without manipulation, each) for the fracture care, 826.0 to represent the diagnosis, E007.0 for the cause of the injury.


Difference in profit: CPT 28515 shells out about $144.17 while 28510 gets you about $109.88.


For further details on this and for other specialty-specific articles to assist your podiatry coding, sign up for a good medical coding resource like Coding Institute.