Orthopedic Coding Alert

Question: The provider performed in-office closed treatment on a patient’s carpometacarpal dislocation of the right thumb. They also buddy taped the patient’s left index and middle finger. How should I report each of these services?

Arizona Subscriber

Answer: On the claim, you should report 26641(Closed treatment of carpometacarpal dislocation, thumb, with manipulation) for the thumb repair. Append modifier F5 (Right hand, thumb) to 26641 to specify the digit the orthopedist worked on.

Roll the work the provider performed during buddy taping into the overall evaluation and management (E/M) service level for the encounter, and report the appropriate code from the 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. …) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. …) code set.

Modifier alert: Remember to append modifier 57 (Decision for surgery) to the E/M code to show that the E/M led to the decision for surgery.