ED Coding and Reimbursement Alert

Question: The physician's notes state "reduction of shoulder dislocation, IV sedation, traction/countertraction." Should I report this with procedure code 23650, or 23655?


New Jersey Subscriber

Answer: In the emergency department, 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) is generally more appropriate than 23655 (... requiring anesthesia).

While there is no specific reference in CPT about the exact definition of anesthesia, American Medical Association personnel have stated that "with anesthesia" is intended to mean "with general anesthesia," not local. The added relative value units associated with the "with anesthesia" codes are not to reimburse the physician for the anesthesia but are supposed to be reimbursement for the added complexity of the procedure that requires anesthesia.

Usually in the ED, the "anesthesia" that the physician provides in conjunction with a dislocation is conscious sedation. Conscious sedation is distinguishable from general anesthesia in that conscious sedation is used to achieve depressed consciousness while maintaining the patient's airway, protective reflexes, and the ability to respond to stimulation or verbal commands.

The best way to code orthopedic services in conjunction with conscious sedation is to use the orthopedic codes "without anesthesia" and add a conscious sedation code.