ED Coding and Reimbursement Alert
Code Order Matters for Optimal Claims
Question: The ED physician performed closed treatment of a metacarpal fracture without manipulation on a patient’s left second digit and closed treatment of a metacarpal fracture with manipulation on a patient’s third left digit. How should I report this encounter? Illinois Subscriber Answer: On your claim, report: 26605 (Closed treatment of metacarpal fracture, single; with manipulation, each bone) for the fracture treatment with manipulation Modifier F2 (Left hand, third digit) appended to 26605 to indicate laterality 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) for the fracture treatment without manipulation Modifier F1 (Left hand, second digit) appended to 26600 to indicate laterality Modifier 51 (Multiple procedures) appended to 26600 to indicate multiple procedures Use this sequence: When reporting this encounter — or any encounter in which your provider performs multiple procedures — be sure to list the higher-paying code first. The payer will reduce payment by 50 percent for the second-listed code in this instance. The numbers: In this scenario, 26605 is worth 3.03 facility work relative value units (RVUs); while 26600 is worth 2.60 facility work RVUs.
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