Reader Question:
Modifier 25 Supports Your Nursemaid's Elbow, E/M Claims
Published on Tue Jul 31, 2012
Question:
Our pediatrician treated a 3-year-old patient for nursemaid's elbow. What procedure code represents this procedure, and which ICD-9 code should I report on this claim?
Connecticut Subscriber
Answer:
You'll 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 before treating the injury.
If the operative 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 on the same day of the procedure or other service) to the E/M code.