ED Coding and Reimbursement Alert

Question: A patient reports to the ED after hurting her leg while roller skating. After a level-three E/M service, the physician determines that the patient has a closed fracture of the tibial shaft alone, which she treats without manipulation. During the course of treating the injury, the ED physician calls an orthopedist to discuss treatment options. The medical record states that the phone call lasted five minutes. Can we bill for the phone call separately?


Minnesota  Subscriber


Answer: There is a CPT code set for phone calls involving patient management or consultations, 99371-99373. But you-ll have a hard time gaining payment for it, and it likely does not apply in this case.

The call your physician made might be coded with 99371 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists]; simple or brief [e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information from other health professionals into the medical treatment plan, or to adjust therapy]).

However, most payers will not reimburse for the phone call, considering it bundled into the overall E/M service as part of medical decision-making.
 
Best bet: Report the E/M service with the appropriate ICD-9 code. On the claim:

- report 27750 (Closed treatment of tibial shaft fracture [with or without fibular fracture]; without manipulation) for the fracture treatment.

- report an E/M service, probably 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity).

- attach 823.20 (Fracture of tibia and fibula; shaft, closed; tibia alone) to 27750 and 99283 to represent the patient's leg fracture.

- attach E885.1 (Fall on same level; fall from roller skates) to 27750 and 99283 to represent the accident that caused the fracture.