ED Coding and Reimbursement Alert

When a patient reports to the ED with multiple fractures, put your treatment codes in the right order using this simple rule:

Code the fracture that required the most care first, advises Michael Lemanski, MD, ED billing director at Baystate Medical Center in Springfield, Mass.

Example: The ED physician performs closed treatment on a tibial shaft fracture using manipulation. During the same session, the physician also performs definitive closed treatment on a distal radial fracture without manipulation, including placing a cast. He then helps the patient coordinate follow-up care with her PCP.

In this instance, you would report the tibial shaft fracture first. On the claim, report the following:

- 27752 (Closed treatment of tibial shaft fracture [with or without fibular fracture]; with manipulation, with or without skeletal traction) for the tibial fracture care

- 25600 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation) for the radial fracture care

- modifier 54 (Surgical care only) appended to 27752 and 25600 to show that the ED physician is coding for only the initial fractures- care.