Orthopedic Coding Alert

Question: When a patient reports to the office for treatment of broken ribs, is there a difference between open and closed treatment coding?

Arkansas Subscriber

Answer: Yes, there certainly is a difference. Per CPT, “To report closed treatment of an uncomplicated rib fracture, use the Evaluation and Management [E/M] codes.”

This means that when your surgeon performs closed treatment for a patient with broken rib(s) in the office, you’d choose a code from 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.). You listed the office at the site for the treatment; if, however, the treatment occurs elsewhere, choose the E/M code that is appropriate for the location (hospital inpatient, ED, etc.)

Even if you’re using an E/M to report the broken rib treatment, there will likely be other coding opportunities for this patient. The surgeon will have to order X-rays in order to confirm that the ribs are broken. For rib X-rays, you’d report one of the following, depending on encounter specifics:

• 71000 (Radiologic examination, ribs, unilateral; 2 views)
• 71001 (… including posteroanterior chest, minimum of 3 views)
• 71110 (Radiologic examination, ribs, bilateral; 3 views)
• 71111 (… including posteroanterior chest, minimum of 4 views)
• Modifier LT (Left side), RT (Right side), or 50 (Bilateral procedure) appended to the X-ray code, depending on the laterality (or bilaterality) of the X-rays

For open treatment of broken ribs, you’d report one of the following codes:

• 21811 (Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs)
• 21812 (… 4-6 ribs)
• 21813 (… 7 or more ribs)

Note: If the patient reports for open treatment for their undiagnosed broken ribs (and it isn’t a referral), there will almost certainly be a separate office E/M service prior to the surgery. If this occurs, be sure to report a code from 99202 through for the E/M with modifier 57 (Decision for surgery) appended.

Explanation: The E/M is not considered preoperative when the surgeon hasn’t even reached a diagnosis yet. They can’t reach a decision for surgery without the a significant, separately identifiable E/M service.