ED Coding and Reimbursement Alert

Question: A patient presents with an elbow fracture/dislocation, which was reduced in the ED. Fluoroscopy was performed in addition to the procedure, to evaluate presence of subluxation. Is this fluoroscopy service included in the E/M code?

Mumbai Subscriber

Answer: The actual CPT® code for treating the dislocated elbow will depend on the nature of the injury, such as 24600 (Closed treatment of elbow dislocation; without anesthesia) or 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). Neither of those codes specifically mentions fluoroscopy included in the descriptor, so it should be separately reportable.  In the ED setting, if the doctor does the fluoroscopy themselves it would be reportable by them using code 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]).   Depending on the code descriptor, the fluoroscopy might be included in the procedure, but CPT® would not include it in the visit level. Of course, payers may choose to bundle the services, so you should verify the policy if those with whom you contract.