ED Coding and Reimbursement Alert

& but certain patient situations might make modifier 54 unnecessary. ED coders will append modifier 54 (Surgical care only) to nearly all procedure codes that include follow-up care. If your physician provides fracture care for a patient, for example, odds are he wont be seeing the patients recovery through to the end. There are exceptions to this rule, however, and they can occur with any type of procedure requiring follow-up care, not just fractures. Physician Must Fill Specialists Role Lets say the ED physician uses manipulation to treat a patients closed humeral shaft fracture. He casts the arm and releases the patient to an orthopedist for follow-up. On the claim, you must append modifier 54 to 24505 (Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction), confirmed Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network, and executive officer on the AAPCs National [...]