ED Coding and Reimbursement Alert

Answer: You get 79 percent of the total Medicare Fee Schedule reimbursement if you use the -54 modifier with the surgery/musculoskeletal series 20000 codes and 81 percent for the surgery/integumentary 10000 series codes. You can use modifier -54 as long as the initial care provided in the ED is fracture or restorative care. For example, splinting a wrist fracture (29125, application of short arm splint [forearm to hand]) so the orthopedist can reduce and cast it in the morning is not fracture care. And, orthopedists will often bill full fracture care for patients even though the ED physician provided the restorative care.