ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a closed dislocation of the left hip. After performing a level-four ED E/M service, the ED physician performs joint reduction without anesthesia. Upon completing the reduction, the physician prescribes painkillers and instructs the patient to follow up with an orthopedic specialist in a week to 10 days. How many, and which, modifiers will I need to make this claim correct?

New York Subscriber

Answer: You should append one modifier to each CPT code you submit. On the claim, report the following:

• 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia) for the reduction
• Modifier 54 (Surgical care only) appended to 27250 to show that the ED physician will not handle the patient's follow-up care
• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the E/M service
• Modifier 57 (Decision for surgery) appended to 99284 to indicate that the E/M led to a decision for surgery
• 835.00 (Dislocation of hip; dislocation of hip, unspecified) appended to 27250 and 99284 to represent the patient's injury.