Pediatric Coding Alert

Question: Our pediatrician treated a 3-year-old patient for nursemaid’s elbow after he fell on the ice during a snowstorm last week. What procedure code represents this procedure, and which ICD-9 code should I report on this claim?

Answer: You should report the procedure with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). On the claim, be sure to link 832.2 (Nursemaid’s elbow) to 24640 to represent the patient’s affliction.

You’ll typically be able to report a separate evaluation and management code along with 24640, assuming that the pediatrician documents an appropriate history, examination of the patient, and medical decision-making that he performed evaluating the trauma before treating the injury.

If the procedural notes justify a separate E/M along with 24640, be sure to attach 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 the E/M code. Optimal documentation would be to provide separate evaluation/management and procedure notes. Distinct diagnoses linked to each CPT code, although not absolutely necessary, would be best.