Revenue Cycle Insider

Question: The emergency department (ED) physician treats a patient who reports to the ED with left wrist pain. The provider performs a history and examination, as well as ordering a wrist X-ray that the hospital radiologist performs and interprets. The ED physician finds that the patient has a Colles’ fracture of the left radius. The physician places a call to the orthopedist on duty, who does not need to see the patient emergently. The ED physician performs closed treatment of the fracture with manipulation. The patient’s wrist is then placed into a splint, a prescription for pain medication is given, and they are provided aftercare instructions: rest, ice, elevation and a reminder to follow up with another physician.

How should I report this encounter?

Texas Subscriber

Answer: Since the ED physician won’t be handling follow-up care — as is usually the case — you’ll need to let the payer know that when you code this encounter. On the claim, you should report:

• 25605 (Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation) for the fracture treatment
• Modifier 54 (Surgical care only) appended to 25605 to show that you are only coding for the fracture treatment, not any follow-up care
• Modifier LT (Left side) appended to 25605 to indicate laterality
• The appropriate ED evaluation and management (E/M) code from the 99281-99285 (Emergency department visit for the evaluation and management of a patient …) set
• Modifier 57 (Decision for surgery) appended to the ED E/M code to show that the E/M and the surgery were separate services
• S52.532A (Colles’ fracture of left radius, initial encounter for closed fracture) appended to 25605 and the ED E/M code to represent the patient’s injury.

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