ED Coding and Reimbursement Alert

Question: I am coding a radiology report written by our ED physician that says, "Posterior dislocation of the radial ulnar unit with respect to the distal humerus, associated with a joint effusion and avulsions of the lateral epicondyle and ulnar coronoid process." Postreduction, the report reads, "Radial ulnar unit has been relocated and articulates with the distal humerus. Olecranon fragment remains a few millimeters distally offset. The lateral epicondyle seems realigned." Which of the fracture treatment codes is appropriate in this case? Maine Subscriber Answer: This report refers to both a dislocation and fracture within the elbow area. Coders considering this patient record may wonder which type of code best describes the treatment. There is no specific code that describes treatment of a fracture dislocation of the elbow, so coders must examine simple dislocation codes. These include 24600 (Treatment of closed elbow dislocation; without anesthesia), 24605 ( requiring anesthesia) or 24615 (Open treatment of acute or chronic elbow dislocation). Coders would immediately discount 24615 because the ED physician would not have performed an open procedure. Neither 24600 nor 24615, however, supports the reduction of the fracture and therefore may not be the most appropriate. Instead, you should focus on the epicondyle fracture treatment and assign 24565 (Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation). It is likely that the ED physician would refer the patient to an orthopedist for outpatient follow-up the next day. In this case, modifier -54 (Surgical care only) would be appended to 24565. If the orthopedist were doing an operative follow-up, coders would use modifier -56 (Preoperative management only). Reader Questions and You Be the Coder were reviewed by David McKenzie, reimbursement department director, American College of Emergency Physicians in Irving, Texas; and Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas.