Orthopedic Coding Alert

Question: How should I code for closed treatment of a humeral shaft fracture? My orthopedist performed the procedure after a level-four evaluation and management (E/M) service for a new patient. We don't see a lot of these claims, so I'm a bit lost.

Missouri Subscriber

Answer: It appears that your provider performed 24500 (Closed treatment of humeral shaft fracture; without manipulation) for the fracture. The treatment was closed, and there is no mention of manipulation in your question. If the provider does not manipulate and performs closed treatment, go with 24500.

If you discover that the provider actually performed manipulation during closed humeral shaft fracture treatment, opt for 24505 (... with manipulation, with or without skeletal traction).

Open/closed difference: According to CPT^®, the provider does not surgically open the fracture site

during closed treatment. Closed fracture claims are often marked by the terms "without manipulation,'' "with manipulation," or "with traction"/"without traction."

Open treatment occurs when:

• the provider surgically opens the area around the injured bone and visualizes the bone ends - the provider might also use internal fixation; or
• the provider opens the fractured bone "remote" from the fracture site. She might perform this opening in order to insert an intramedullary nail.

Also, you'll report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity ...) for the E/M with modifier 57 (Decision for surgery) appended.