Orthopedic Coding Alert

Question: Our orthopedist gave orders to do an inpatient admit for a patient previously diagnosed with a stroke who fell and fractured his proximal tibia. The fracture in the proximal tibia was treated by closed reduction. That order was later changed by case management to observation per hospital guidelines. Due to other health issues, the patient was in observation for several days. How do we report this?

Should I charge ‘27530’ (Closed treatment of tibia fracture) along with ‘99218’ (Obs Adm/Dis Diff Date) with a 57 modifier? If there is a better option please advice.

Massachusetts Subscriber

Answer: You report code 27530 (Closed treatment of tibial fracture, proximal [plateau]; without manipulation) for the closed reduction of the proximal tibia.

You report code 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components:…) for the observation. You append modifier 57 (Decision for surgery…) to 99218.

However, it seems that the patient is under observation status for the neurology condition and not the fracture. If so, your orthopedist should report the services rendered for treating the fracture and leave the observation status to the medical service.