# Treating Fractures in ED



## Mindy Davis (Nov 18, 2009)

I'm needing some input on what the ED can bill for and what they can not bill for when it comes to fractures. 

Say we have a pt that has a displaced fracture of their bimalleolar and the ED doctor adminstered Conscious Sedation, he also reduces the fracture and applies a sugar-tongue split but the pt is admitted to the hospital under Othopadeic from the ED. 

How do we code approaitely?


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## AuntJoyce (Nov 18, 2009)

*Treating fractures in the ED*

Good morning,

I am reaching here but I believe that since the ED doc did the manipulation, he/she can bill 27810-54.  Obviously, once the patient is admitted to the Orthopaedic service, that particular code will not be utilized again as long as the manipulation resulted in a good reduction of the fracture.  In the event the patient goes on to have open surgery, an entirely different code will be used.  By appending the -54 modifier, you are telling the insurance carrier that your ED doc performed ONLY the surgical portion (even though no actual surgery was performed, care of fractures is considered in the surgery section).

Hope this helps.

Joyce


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## kak6 (Nov 19, 2009)

Nice answer Joyce, I agree.


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## Mindy Davis (Nov 20, 2009)

*Thanks for your response*

I'm new to ER billing and I just want to make sure that if I bill for services that my docs have performed that they meet CMS guidelines.


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## AuntJoyce (Nov 20, 2009)

*Treating fractures in the ED*

You are very welcome.  I think coders networking is just the greatest thing especially for coders that work alone and have no one to bounce things off of.  You put your question out there and sometimes it's like a feeding frenzy - you get dozens of replies.  Sometimes I wish that reading the posts and responding was my full time job - it makes you do a lot of thinking.

Have a great weekend and a great Thanksgiving!

Joyce


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## jeanae1005 (Nov 24, 2009)

Hopefully I can get some help here as well.  I do the billing for a Free Standing Emergency Room.  We are contracted thru Medicare as an Urgent Care facility.  We dx and then tx a pt's fx back in Aug '09.  The pt came in again in Oct, and Medicare is denying our E/M for global period to a sx code (the fx charge).  The pt was seen for upper resp infection, and nothing to do with the fracture, we billed out 99214-25.  Are they correct in denying this?


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## FTessaBartels (Nov 25, 2009)

*to jhernandez*

jhernandez wrote:  The pt was seen for upper resp infection, and nothing to do with the fracture, we billed out 99214-25. Are they correct in denying this? 

*Wrong modifier *... try -24 unrelated E/M in the postoperative period.

F Tessa Bartels, CPC, CEMC


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