ED Coding and Reimbursement Alert

Question: I know I’ve seen this before, but I get confused with orthopedic procedures. What is the difference between an open and closed fracture treatment?

California Subscriber

Answer: You’ll need to know the difference between the two, because your code choice is based on whether the physician performed open or closed repair. According to the CPT® definition, fracture care should be described by the type of treatment provided and not by the type of fracture. Consider these definitions:

Closed definition: When the emergency physician performs closed fracture treatment, it means that they did not have to surgically open the fracture site in order to repair the break. So if the operative report indicates that the physician performed closed treatment of a patient’s broken rib, you’d report 21800 (Closed treatment of rib fracture, uncomplicated, each) for the repair.

Open definition: When the physician performs open fracture treatment, they either: surgically open the fracture site and performs internal fixation; or expose the fracture site remotely and inserts an intermedullary nail. However, due to the equipment needed for the procedure and the high risk of infection, open fractures are typically fixed in the operating room, not the ED.

Example: A thoracic surgeon performs an open repair on a patient’s sternum, you’d report 21825 (Open treatment of sternum fracture with or without skeletal fixation) for the repair.

Beginning coders often get confused between the definitions of open and closed treatment as noted above and open or closed fractures, which refers to the fracture itself protruding through the skin so that the injury is open to the air rather than broken, but contained within the skin and muscle of the surrounding area of the injury

Don’t forget modifier 54: Nearly all ED fracture care claims include modifier 54 (Surgical care only), because the ED physician is only treating the fracture, not providing any follow-up care. CPT® reports that you must append modifier 54 to your fracture care claims unless the ED physician performs the follow-up services during the global period which is typically 90 days.