Orthopedic Coding Alert

You should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity …) for the E/M along with modifier 24 ( (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period) to show that the E/M was unrelated to any issues the patient might have arising from the Boxer’s fracture. Also, remember to append M25.511 (Pain in right shoulder) to 99213 to represent the patient’s shoulder pain, which will help differentiate this E/M from any postoperative follow-up visits that would be included in the surgical package for the Boxer’s fracture fix.

Boxer’s fracture: The code for surgical treatment of a Boxer’s fracture is 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone), which has a global period of 90 days. According to Cedars Sinai, “a boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand.”

Symptoms can include:

• “Painful bruising and swelling of the back and front of the hand.
• “Pain of the back of the hand in the area of the fractured fifth metacarpal.
• “Bent, claw-like pinky finger that looks out of alignment.
• “Limited range of motion of the hand and of the fourth and fifth fingers.”

If the E/M had been related to the fracture repair — say, the patient complained of pain — it would be part of the surgical package for the fracture. That’s why the diagnosis for shoulder pain and modifier 24 are vital to the success of your 99213 claim.