ED Coding and Reimbursement Alert

Question: Our ED physician attempted to reduce a fracture of the left hip, but was unable to do so. He used conscious sedation for the procedure. We’re planning to report 27265, 99285 and 99152, but we aren’t sure if any modifiers are necessary. Can you advise?

Codify Subscriber

Answer: In this situation, you would report the following codes and modifiers on your claim:

• 99285-57 (Emergency department visit for the evaluation and management of a patient,… Decision for surgery)
• 27265-52-LT (Closed treatment of post hip arthroplasty dislocation; without anesthesia,… Reduced services, Left side)
• 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older)

The Correct Coding Initiative bundles 99285 into 99152, but the use of modifier 57 will allow you to bill both services together.