Orthopedic Coding Alert

Question: The orthopedic surgeon saw a patient in the emergency department for a medial elbow dislocation. The surgeon attempted multiple reductions without success (probably because of interposed soft tissue), so he transferred the patient to another hospital and physician for an open reduction internal fixation (ORIF). What code should I report?

California Subscriber

Answer: You may report closed elbow dislocation treatment, but you will need to append a modifier to tell the full story.

On the claim, submit the following:

• 24600 (Treatment of closed elbow dislocation; without anesthesia) or 24605 (- requiring anesthesia) for the elbow reduction, depending on whether the surgeon used anesthesia
• modifier 52 (Reduced services) appended to 24600 or 24605 to show that you are not reporting a fully successful reduction
• modifier 54 (Surgical care only) also appended to 24600 or 24605 if you transfer the patient to another facility
• S53.13-- (Medial dislocation of ulnohumeral joint …) to show the reason for the reduction.