Orthopedic Coding Alert

Question: My orthopedist treated a patient who was first seen in the ER for an open fracture with laceration overlying the distal finger phalanx. The ER physician sutured the wound. When the patient arrives in our office, the orthopedist does an E/M service and assumes the care of the wound in addition to the fracture care. Should I report our orthopedist's E/M service or does that qualify as double-dipping?

New Hampshire Subscriber

Answer: If your orthopedist didn't do anything in addition to treating the fracture (such as splinting, casting, and so on), then you should bill the E/M service (such as 99214, Office or other outpatient visit ...). You might try applying modifier 55 (Postoperative management only), but you need to make sure the service the ER physician performed has more than a "0" day global. Many wound repair codes are minor procedures that have 10 day global periods.

If your orthopedist treated the fracture, you should report the appropriate fracture code. Your facture code could be 26750, Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each, or 26755, ... with manipulation, each, depending on whether the orthopedist performed the manipulation).