ED Coding and Reimbursement Alert

Question: A patient presented in the ED with a fracture of the tibia involving the medial malleolus. The ED physician consulted an orthopedist, who told her to reduce the injury as much as possible and send the patient to the orthopedic clinic, where the orthopedist would perform the rest of the care. The ED physician placed the patient under conscious sedation and reduced the fracture enough to make the patient comfortable.

Due to the extent of the ligamentous damage, the ankle remained unstable and the joint continued to sublux significantly. The physician placed a splint to relieve the continued subluxation and sent the patient home with instructions to see the orthopedist the next day. What services can we bill?


Iowa Subscriber

Answer: You may or may not opt to bill for the manipulation based on your group's policy on the subject. Some groups choose not to bill if the patient endured a great deal of pain because of incomplete reduction and the ED physician had to consult another doctor.

Other groups think that because the physician did perform reduction--regardless of whether it was complete--they should bill for the service. If your group does decide to report the reduction, you-ll report 27762 (Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction).
 
Remember to append modifier 54 (Surgical care only) to indicate that the emergency physician will not provide the follow-up care. Also, you may want to consider appending modifier 52 (Reduced services) if the physician was unable to complete the whole reduction.