Remember These Clues for Manipulation Question
Question: A patient reported with an anterior displaced fracture of the sternal end of the right clavicle, which the emergency department (ED) physician used closed treatment to repair. I see that there are two codes for closed treatment of clavicular fracture: with and without manipulation. How can I tell if the provider used manipulation to treat the fracture? RCI Subscriber Answer: There should be clues throughout the notes to indicate whether the ED physician used manipulation on the patient’s fracture. Without manipulation: When the ED physician performs closed fracture treatment without manipulation, it means they didn’t use force to put the bone back into place. Instead, the ED physician would have splinted, casted, or otherwise immobilized of the fracture. Closed treatment is employed if the bone is well-aligned and the fracture shows minimal (or no) displacement. If the ED physician performed closed treatment of the fracture without manipulation, report 23500 (Closed treatment of clavicular fracture; without manipulation) for the service with modifier RT (Right side) appended to indicate laterality. Also, append S42.011A (Anterior displaced fracture of sternal end of right clavicle, initial encounter for closed fracture) to 23500 to represent the patient’s fracture. With manipulation: When the ED physician performs closed fracture treatment with manipulation, it means that they had to use force to manually move the bone back into place. This type of fracture will often be casted or splinted as well. ED physicians use manipulation when the closed fracture is displaced and needs to be realigned in order for the patient to recover properly. If the ED physician performed closed treatment of the fracture with manipulation, report 23505 (… with manipulation) with modifier RT and S42.011A appended. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
