ED Coding and Reimbursement Alert

Question:

A 4-year-old girl reports to the ED with her mother; the mother says the child slipped on the porch steps and injured her right wrist the previous day. The mother says that she noticed some swelling when the injury occurred, and the child seemed to be in significant pain due to the injury. The next morning, the mother noticed that the child was still not using her arm normally. Physical exam notes indicate that the patient was alert, and her wrist was swollen and tender. After a level-four ED E/M, the physician orders a two-view wrist x-ray, which shows a displaced fracture of the distal radius; final diagnosis of the injury is Colles fracture. The physician performs a hematoma block and reduces the fracture, then places the patient's wrist in a short-arm cast, immobilizes the wrist and tells the mother to schedule follow-up visits with the orthopedist in three to five days. How should I code this scenario?

North Dakota Subscriber

Answer:

On this claim, you can report ED E/M, x-ray and fracture care codes " but don't forget the modifiers or your claim could face red tape.

On the claim, report the following:

25605 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation) for the fracture care

Modifier 54 in a nutshell: ED coders should be very familiar with modifier 54, as it will be appended to many procedure codes that you'll file for your physician's services. In short, if the CPT^® code has follow-up care figured into its work units, you'll need to append modifier 54 to show that you are only coding for the physician's surgical services.

Exception: Rarely, an ED physician will provide follow-up care for patients. These are exceptions, however; another physician is usually responsible for an ED patient's follow-up care.