ED Coding and Reimbursement Alert

Question: Our ED physician treated a 3-year-old patient for nursemaid elbow. What procedure code represents this procedure, and what ICD-9 code should I report on this claim?

Connecticut Subscriber
 
Answer: You-ll report the procedure with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation).
 
On the claim, be sure to link 832.00 (Closed dislocation of elbow unspecified ) to 24640 to represent the patient's affliction.
 
You-ll typically be able to report a separate evaluation and management code along with 24640, since the ED physician will take a history, examine the patient and then make the medical decision before treating the injury.
 
If the op notes justify a separate E/M along with 24640, be sure to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M.