ED Coding and Reimbursement Alert

Question: What does "closed treatment" mean in the case of a rib fracture? The standard care for rib fractures is generally rest and pain control. Should I report an orthopedic code with modifier -54 (Surgical care only)?

Michigan Subscriber

Answer: CPT defines fracture care by the type of treatment the doctor provides, not by the type of fracture. "Closed treatment" specifically means that the physician does not surgically open the fracture site. An emergency department physician usually provides closed treatment only, even when caring for an open fracture.

As with all of the CPT surgical codes, use of code 21800 (Closed treatment of rib fracture, uncomplicated, each) without a modifier indicates that the physician is providing restorative care and any subsequent patient care usual to the management of this condition. So, the ED physician's overall management should be comparable to that provided by other physicians performing the same service.

For example, you shouldn't separately report complications, pain treatment, patient education, or follow-up care, and take into account the patient's relevant circumstances. If the emergency physician does not expect to provide the follow-up care usual for such condition, modifier -54 should be appended to the fracture code.

-- Reader Questions and You Be The Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, the vice president of Medical Reimbursement Systems in Stoneham, Mass.