ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of severe right elbow pain. After an expanded problem focused history and examination the physician diagnoses a closed anterior humeral elbow dislocation. The physician uses manipulation to reduce the joint, prescribes painkillers and instructs the patient to follow up with his primary care physician (PCP) in two weeks. What is the best CPT code for the reduction?

Wisconsin Subscriber

Answer: The AMA's stance is that the intent of the "with anesthesia" codes is to reflect a formal process performed in the operating room As a result, you would typically use the "without anesthesia" code 24600 (Treatment of closed elbow dislocation; without anesthesia)

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity...) for the E/M
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the E/M and the reduction were separate services
• 832.01 (Dislocation of elbow; closed dislocation; anterior dislocation of elbow) appended to the reduction code and 99283 to represent the patient's injury.