Practice Management Alert

Question: An established patient reported to the practice on for treatment of a broken left index finger. The physician performs closed treatment of the fracture without manipulation. Twelve days later, the patient reports complaining of ongoing nasal congestion, unproductive cough, and fatigue. Notes indicate a level-two E/M service. The same physician that performed the fracture repair diagnoses acute maxillary sinusitis, writes the patient a prescription, and sends him home. Can I report these services separately?

Tennessee Subscriber

Answer: Yes, you can report the services separately — provided you include the proper modifiers and diagnoses to prove that the services were unrelated.

Fracture: For the fracture care, report 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) with S62.601 (Fracture of unspecified phalanx of left index finger) appended to represent the patient’s injury. If the payer requires LT/RT site modifiers, append modifier LT (Left side) to 26600.

Sinus infection: You should code the sinus infection encounter as 99212 (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 problem focused history; a problem focused examination; straightforward medical decision making…) with modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) appended to ensure that the payer knows the E/M is not related to the finger surgery. Also, be sure to append J01.00 (Acute maxillary sinusitis, unspecified) to 99212 to show the payer that the E/M service was unrelated to the patient’s fracture.

You’ll use modifier 24 whenever the same provider performs an unrelated service (sinus infection treatment) for a patient during the global period of another procedure (finger fix). The global period for 26600 is 90 days, so modifier 24 is necessary to show the payer that the E/M and finger repair were unrelated.