# FX reduced in ER w/intend other surgery



## KELLERCC (Sep 29, 2011)

I work in a teaching hospital and do medical coding for the Emergency Room attending profession component. If a patient has a bone fracture splinted/casted in the ER. The ER attending and resident perform this procedure. Due to the fracture being unstable the patient is either admitted for surgical fixation of the fracture or has a follow-up visit to schedule the surgery. 
Should I bill for a closed fracture treatment without manipulation with a 54 modifier or for the E/M and cast only?


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## jimbo1231 (Sep 30, 2011)

*Stabilized*

This looks like a case where stabilization pre surgery was provided as opposed to restorative treatment which would be billable as fracture care. 54 or surgical care only wouldn't be available since the surgery is in the OR. So I would go with a Level (At least 99284 depending on documentation) and splinting.

Jim Strafford  CEDC  MCS-P


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## LTibbetts (Oct 11, 2011)

Hey Jim...

I have one for you that I could use your help on if you could...

I had a patient come in with a chronic dislocation of the shoulder. My er doc attempted to reduce with no luck. He consulted another er doc to come and that doc used conscious sedation, sheet traction, and felt that it was successful, however, after post procedure x-ray, the dislocation was not reduced so the initial er doc put the patient in a sling and sent him off to an ortho specialist for followup.

What is codeable? Both docs work in the same hospital, but only one was acting hospitalist that day (the second one).


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