ED Coding and Reimbursement Alert

Heal your reimbursement with these strategies

If you're having trouble picking fracture and dislocation codes, differentiating between open and closed treatments, and deciding on strap and splint codes, refresh your memory -- and your bottom line -- with these foolproof guidelines. Don't Mix Up Treatment Types
 
Physicians treat fractures in four different ways, says Mary Brown, CPC, coding specialist for Ortho West PC in Omaha, Neb.: closed treatment, closed treatment with manipulation, percutaneous skeletal fixation, and open treatment. An open fracture doesn't always translate into open treatment (and the same is true for closed fractures and treatment), so be careful when deciding how to apply these terms. "Remember that open and closed fracture types -- the diagnosis codes -- have no correlation with the type of treatment," she says.

For open fractures, the physician may perform either open or closed treatment. "Closed treatment specifically means that the physician did not surgically open the fracture site. Open treatment is performed when the surgeon opens the fracture site and exposes it to the external environment, or when he opens it 'remotely' from the fracture site in order to insert a nail across the fractured bone," says Mike Granovsky, MD, CPC, FACEP, chief financial officer at Greater Washington Emergency Physicians in suburban Maryland. Was Manipulation Involved? The next element that you need to determine is whether the case involves manipulation. When a fracture is not displaced, it is close to or in anatomic alignment. Consequently, the physician will not have to perform manipulation to treat the break. But, if the fracture is significantly out of place, the doctor may need to "move," "distract," "reposition," "realign" or "apply tension" to manipulate the displaced bone into correct anatomic position. In the case of minimal misalignment, as often occurs with incomplete fractures, the physician may not need to perform any manipulation.

For instance, a child falls off his bicycle and fractures the middle phalanx bone of his index finger. X-rays show a hairline fracture that is relatively in alignment. The physician reduces the bone. Because no manipulation is involved, you should report 26720 (Closed treatment of phalangeal shaft fracture ... finger or thumb; without manipulation, each). In contrast, if the doctor had to reposition the displaced bone, you would instead assign 26725 (... with manipulation, with or without skin or skeletal traction, each).

Or suppose a patient presents in the emergency department with a broken toe (826.0), so the definitive care is buddy taping. Since the physician didn't open the fracture site, you would report closed treatment with 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each).

If your physician's documentation doesn't specify open treatment, you are generally correct to report closed treatment, considering the statement [...]