ED Coding and Reimbursement Alert

Question: A patient presents with a fracture of the ankle. It was severe enough to compromise the circulation to the foot. When caring for the fracture dislocation, the emergency physician reduced the dislocation immediately. The orthopedist then took the patient to the OR for further treatment. Which CPT codes are more appropriate: fracture care, or reduction of dislocation? Can I code for both?

Mississippi Subscriber

Answer: You should code and bill only for the reduction, e.g., 27846 (Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation). Do not code for fracture care, i.e., 27814 (Open treatment of bimalleolar ankle fracture, with or without internal or external fixation), because the orthopedist performed the definitive fracture care. They are separate services performed by separate practitioners.

However, occasionally you can code both fracture care and dislocation. For instance, an elderly patient who falls presents a shoulder dislocation, 831.00 (Dislocation of shoulder, unspecified), and a proximal humeral fracture, 812.00 (Upper end, unspecified part).

You can bill separately for treatment for these two conditions even though they occurred in the same anatomic area. For example, you can bill the reduction with 23650 (Closed treatment of should dislocation, with manipulation; without anesthesia) and the fracture care with 23600 (Closed treatment of proximal humeral [surgical or anatomical neck] fracture; without manipulation).

Because neither of these procedures is exempt from modifier -51 (Multiple procedures), list them in the order of significance and recognize that you will receive reduced payment for the second procedure. And don't forget modifier -54 (Surgical care only) for fracture codes because the ED physician will not do the follow-up.