ED Coding and Reimbursement Alert
Exclude Sedation Code From Fracture Claim
Question: When the ED physician performs a fracture reduction, is conscious sedation included or should I report it separately?
Alabama Subscriber
Answer: No, conscious sedation isn't technically included in the code for the fracture reduction. However, payers that follow Medicare rules don't reimburse for conscious sedation services in the emergency department. For private payers, you'll need to check with the individual carrier, because they may have varying policies on this issue.
If you have sufficient documentation, you may potentially include the risk associated with the conscious sedation in your E/M service and capture high risk in the medical decision-making (MDM) risk table.
The following codes include conscious sedation administration:
ED Coding and Reimbursement Alert
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