ED Coding and Reimbursement Alert

Question: The ED physician ordered an x-ray for a patient that revealed broken ribs. He gave the patient pain medication and sent her home. Should we charge for an E/M service and fracture care?


Iowa Subscriber

Answer: The requirements to bill for fracture care are that the ED physician provided restorative care (moved the bones back into position) or definitive care (the same care a specialist in the field would provide).

For rib fractures, definitive care is frequently nonoperative and does not involve splinting or strapping. Instead, this care involves pain control and patient education, in which the physician talks to the patient about signs and symptoms to be aware of and when to seek further medical attention.
 
For significant rib fractures, physicians often provide patient education with an incentive spirometer to prevent pneumonia. If your physician met the requirements for definitive care, you may report 21800 (Closed treatment of rib fracture, uncomplicated, each) for each rib fracture.
 
Since the ED physician will not be providing the follow-up care, remember to append modifier 54 (Surgical care only).

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an emergency department billing service in Stoneham, Mass.