Orthopedic Coding Alert

Question: Encounter notes indicate that after a level-four office-evaluation and management (E/M) service for a new patient, the provider performs closed treatment of a clavicular fracture. How should I report this scenario?

Washington Subscriber

Answer: You should choose from the following codes for the fracture fix, depending on encounter specifics:

• 23500 (Closed treatment of clavicular fracture; without manipulation)
• 23505 (… with manipulation)

Then, report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.) for the E/M service.

Modifier alert: Finally, append modifier 57 (Decision for surgery) to 99204 to show it was a significant, separate service from the clavicle repair. All three of your code options have major (90-day) global periods, meaning that you need to use modifier 57 to separate the E/M from the procedure.

If the procedure’s global period was minor (0 or 10 days), then you would append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99204.