Primary Care Coding Alert

Question: An established patient reports to the FP with an injured right finger he suffered during a skiing accident. The physician diagnoses a closed metacarpal fracture, which he resets using manipulation and places in a plaster cast. The physician tells the patient to follow up with an orthopedist for continuing care. Notes indicate a level-two pre-procedure E/M service. What modifier should I append to the E/M code? North Carolina Subscriber Answer: Most insurers will want to see modifier 57 (Decision for surgery) on the E/M. There are exceptions, however. Medicare, and a number of private payers, prefer modifier 57 each time the physician provides definitive fracture care and an E/M in the same encounter. For these payers, report the following: • 26605 (Closed treatment of metacarpal fracture, single; with manipulation, each bone) for the fracture care; • modifier 54 (Surgical care only) appended to 26605 to show that you are coding the [...]