ED Coding and Reimbursement Alert

Question: A man with a severely swollen left elbow reports to the ED. During a level-three evaluation and management service, the physician diagnoses a closed left elbow dislocation. The physician then reduces the joint, and the procedure says under anesthesia. How should I code this case?

Missouri Subscriber

Answer: You-ll be able to report one CPT code for the dislocation reduction and an E/M service. On the claim, report the following codes:

- 24600 (Treatment of closed elbow dislocation; without anesthesia). The AMA has made clear that the procedural terms with anesthesia refer to those procedures performed in the operating room that involve significant resources and additional physician time for scrubbing and standby -- as well as OR prep time.

- 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) for the E/M service.

- ICD-9 code 832.00 (Closed dislocation of elbow; unspecified) attached to 24600 and 99283 to prove medical necessity for the services.

Also: Remember to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99283 to show that the E/M and reduction were separate services.

For a full discussion of moderate conscious sedation, check out "When You See a -Targeted- Code, Think Twice Before Reporting Moderate Sedation" in the March 2007 issue of ED Coding Alert.