# 99203 or 99204????



## Karalea88 (Mar 24, 2021)

New patient is seen for wrist injury and x-rays performed in office determined there is a fracture.  It is decided that it does not require surgery, and it is treated with either a  cast, splint, or brace.  Physician does not review any outside records or test.  Patient only being seen for this injury. What level would this be?  99203 or 99204?  I think it is 99203 but just want to get clarification.  Any feedback is appreciated!!


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## rthomas@impcna.com (Mar 24, 2021)

Going off the information you provided above I would say 99202 (MDM: Straightforward)
Problem: low - acute, uncomplicated injury
Data: Straightforward - Only a X-ray was ordered, but you can't count since you will be billing the x-ray.
Risk: Straightforward - Nothing to indicate otherwise


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## meshemail6@gmail.com (Mar 24, 2021)

Karalea88 said:


> New patient is seen for wrist injury and x-rays performed in office determined there is a fracture.  It is decided that it does not require surgery, and it is treated with either a  cast, splint, or brace.  Physician does not review any outside records or test.  Patient only being seen for this injury. What level would this be?  99203 or 99204?  I think it is 99203 but just want to get clarification.  Any feedback is appreciated!!


99203...I only use 99204 for PostOps


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## Karalea88 (Mar 25, 2021)

rthomas@impcna.com said:


> Going off the information you provided above I would say 99202 (MDM: Straightforward)
> Problem: low - acute, uncomplicated injury
> Data: Straightforward - Only a X-ray was ordered, but you can't count since you will be billing the x-ray.
> Risk: Straightforward - Nothing to indicate otherwise


Thank you for your response.  If cast was treatment, would this make it a low risk, since the physician has to make sure cast is applied properly or would it still fall under minimal risk?


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## rthomas@impcna.com (Mar 25, 2021)

Karalea88 said:


> Thank you for your response.  If cast was treatment, would this make it a low risk, since the physician has to make sure cast is applied properly or would it still fall under minimal risk?


Ortho is not my specialty and this is just based on the info you have provided but I would still say 99202 if cast was applied because I am assuming you are charging for the application of the cast as well. If you feel its a 99203 just make sure the provider has the documentation to back it up.


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## SharonCollachi (Mar 25, 2021)

Unless you're billing on time, and he spent 30-44 minutes with the patient on things that are not billed separately (like the casting), then you could get a 99203 out of it.


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## csperoni (Mar 25, 2021)

I don't code for ortho either, but I would consider a broken bone requiring a cast low risk, not minimal risk.  I agree with low number/complexity of problems (level 3) and straightforward for data (level 2).  That leads to 99203.


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## Alfaro33 (May 27, 2021)

Karalea88 said:


> New patient is seen for wrist injury and x-rays performed in office determined there is a fracture.  It is decided that it does not require surgery, and it is treated with either a  cast, splint, or brace.  Physician does not review any outside records or test.  Patient only being seen for this injury. What level would this be?  99203 or 99204?  I think it is 99203 but just want to get clarification.  Any feedback is appreciated!!


99203. 

Fracture would be an acute complicated injury for a Moderate complexity problem, SF data, and a Low risk since the provider did make a medical decision for the cast placement instead of surgery.


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