ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician performed an evaluation and management (E/M) service for a patient who hurt their ribs playing football. They were hit in the ribs by an opponent’s helmet during a tackle. They then ordered a left-sided four-view rib x-ray with posteroanterior chest exam. After interpreting the films and diagnosing two closed rib fractures on the patient’s left side, the physician sends the patient to the operating room (OR) for treatment on the pair of ribs. How should I code this encounter?>

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Answer: On your claim, report:

• 71111 (Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views) for the X-ray
• Modifier 26
• A 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 for the E/M, depending on the specifics of the encounter. Remember not to count the “Data” point for independent interpretation of the tests in selecting your medical decision making (MDM) level if you are separately reporting the interpretation and report of the x-rays.
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to the E/M code to show that it was a significant, separate service
• S22.41XA (Multiple fractures of ribs, right side, initial encounter for closed fracture) appended to 71111 and the E/M code to represent the patient’s rib fractures
• W21.81XA (Striking against or struck by football helmet, initial encounter) appended to 71111 and the E/M code to represent the cause of the patient’s rib fractures.