ED Coding and Reimbursement Alert

Question: A patient reports to the emergency department (ED) complaining of severe pain in their right wrist. The physician performs a history and examines the patient’s wrist, which shows signs of swelling. The patient also has limited range of motion, and ranks their pain at 7 on a scale of 10. The physician orders a three-view right wrist X-ray and performs the interpretation, which shows no fracture or dislocation. The patient’s final diagnosis is a sprain of the carpal joint in the right wrist. The ED physician applies a dynamic short-arm splint and provides the patient with follow-up care instructions. Medical decision making (MDM) for the evaluation and management (E/M) service is low. How should I code this encounter?

AAPC Forum Participant

Answer: If you’re careful to use the proper modifiers, you’ll be able to report codes for the ED (E/M) service, the X-ray, and the splint placement.

On your claim, you should report:

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making) for the ED E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the E/M was a significant and separately identifiable service
• 73110 (Radiologic examination, wrist; complete, minimum of 3 views) for the X-ray
• Modifier 26 (Professional component) appended to 73110 to show that you are only billing for the ED physician’s services, not the technical component of the code
• Modifier RT (Right side) appended to 73110 to indicate laterality
• 29125 (Application of short arm splint (forearm to hand); static) for the splint application
• Modifier RT appended to 29125 to indicate laterality
• S63.511A (Sprain of carpal joint of right wrist, initial encounter) appended to 99283, 73110, and 29125 to represent the patient’s wrist sprain.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC