Orthopedic Coding Alert

Question: A patient presented to the Emergency Room and the surgeon performed closed reduction and manipulation for a trimalleolar ankle fracture. The closed reduction didn't work so he returned to surgery to repair the fracture the next day. How should I code both surgeries? Montana Subscriber Answer: You'll need to code for three services: the initial visit and examination, the first surgery, and the second surgery. If the patient was treated in the Emergency Room,choose from 99283-99285 (Emergency department visit for the evaluation and management of a patient ...). If the patient was admitted to the hospital before the decision for surgery was made, report 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...) instead. Append modifier 57 (Decision for surgery) to the correct E/M code. For the original ankle repair, submit 27818 (Closed treatment of trimalleolar ankle fracture; with manipulation). Include modifier LT [...]