ED Coding and Reimbursement Alert

READER QUESTIONS:

Consider Some 'Consults' Part of Pre-Op E/M

Question: My ED physician treats a patient with a severely deformed and injured left clavicle. He performs a level-four E/M, during which he orders x-rays that confirm a closed significantly displaced acromial clavicular fracture. The ED physician consults with an orthopedist, and she recommends closed treatment, a sling, and hospital admission for overnight observation.The physician administers a shot of morphine, then performs closed treatment without manipulation and puts the shoulder in a sling. The physician offers overnight hospital admission for monitoring, but the patient refuses. So the physician releases the patient after helping him schedule a follow-up with an orthopedist. Is the consultation with the orthopedist part of the ED E/M service? Indiana Subscriber Answer: The ED consultation with the orthopedist adds to the complexity of the visit and is a consideration in valuing the overall medical decision making. On the claim, report the following: • 23500 (Closed treatment of [...]
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