ED Coding and Reimbursement Alert

Reader Questions:

Use E/M for Broken Nose Tx Without Manipulation

Published on Tue Sep 12, 2023

Question: A patient presents to the ED with a bloody and bruised nose they suffered during a soccer match. The physician is able to stop the bleeding with nasal packing and gauze during the course of the evaluation and management (E/M) service. The ED physician orders and interprets a three-view nasal X-ray, then diagnoses a broken nose. The physician is able to treat the nose without manipulation. How should I report this encounter? I was going to report 21315 for the nose fix.

AAPC Forum Participant

Answer: You should not report 21315 (Closed treatment of nasal bone fracture with manipulation; without stabilization) for this repair. Per CPT^®, “For closed treatment of nasal bone fracture without manipulation or stabilization, use appropriate E/M code.”

So, on your claim you would report:

The appropriate-level ED E/M code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set.

70160 (Radiologic examination, nasal bones, complete, minimum of 3 views) for the X-ray
Modifier 26 (Professional component) appended to 70160 to indicate that you are only coding for your physician’s work on the X-ray, not the equipment used.
S02.2XXA (Fracture of nasal bones, initial encounter for closed fracture) appended to the E/M code and 70160 to represent the patient’s broken nose
Y93.66 (Activity, soccer) appended to the E/M code and 70140 to represent the external cause of the patient’s broken nose.