ED Coding and Reimbursement Alert

Question: I have a claim in front of me that is completely bewildering. Notes indicate that the ED physician saw a patient with “elbow Fx, Monteggia.” What is a Monteggia fracture, and how do I code it?

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Answer: This condition occurs when the patient has a combination of a radial head dislocation and an ulnar fracture. ED physicians may be involved in examining and diagnosing patients with this condition, but less frequently perform the treatment for it, which is usually referred to an orthopedic surgeon. However, in some rural EDs where an orthopedist is not available, the ED physician may handle a closed Monteggia fracture treatment, which you would report with 24620 (Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation).

ICD-10 coding:  Since this is a very specific type of injury, spot-on diagnosis coding is a must. When you see a Monteggia type fracture on a claim, you’re likely to choose from these diagnosis codes:

• S52.271- — Monteggia’s fracture of right ulna
• S52.272- — Monteggia’s fracture of left ulna
• S52.279- — Monteggia’s fracture of unspecified ulna.

If you’re unsure about your payer’s policy on reporting 24620 or 24635, be sure to double-check its diagnosis requirements.