ED Coding and Reimbursement Alert

Question: A patient reported to the emergency department three weeks ago for pain in his right shoulder. The physician treated him for a fractured clavicle. Yesterday, the same patient came into the ED with a fever and nausea. The physician treated both symptoms and sent him home. Can we report this visit, or is it part of the fracture-care global package?

Arizona Subscriber

Answer: Since the fever and nausea were not related to the clavicle fracture, you can report them separately. Code the ED E/M service from the 99281-99285 series based on the chart documentation. Depending on your payer's requirements, you may want to append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to show that the second visit should not be bundled with the initial fracture care. Alternatively, you may submit the ED notes on appeal after a denial to describe why you reported these procedures.

Don't forget modifier -24, or the claim may be rejected. (The modifier indicates that the E/M service was unrelated to the previous fracture care.)