ED Coding and Reimbursement Alert

Question: A 12-year-old boy reports to the ED with his mother complaining of pain -up and down- his right arm. He says the injury happened the week before when he fell off his bike. The physician performs a level-three evaluation and management service, orders an x-ray and decides that the patient has a non-displaced hairline closed fracture of his humerus. He then applies a long arm posterior splint, puts the patient's splinted arm in a sling and helps him make an appointment with an orthopedist for further treatment. How should I report this patient's visit?


New York Subscriber


Answer: You should be able to report codes for application of casts and strapping and a separate E/M service in this scenario. On the claim,

- report 29105 (Application of long arm splint [shoulder to hand]) for the splint application.

-  report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem- focused history; an expanded problem-focused examination; medical decision-making of moderate complexity) for the E/M service.

-  append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99283 to show that the E/M service was significant and separate from the fracture care.

-  link ICD-9 code 812.20 (Fracture of humerus; shaft or unspecified part, closed; unspecified part of humerus) to 99283 and 29105 to represent the patient's arm injury.

-  link ICD-9 code E826.1 (Pedal cycle accident; pedal cyclist) to 99283 and 29105 to represent the cause of the patient's arm injury.