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ED Coding and Reimbursement Alert

Reader Questions:

Use Reduced-Services Modifier for Failed Procedures

Published on Sat Jul 15, 2006

Question: A patient came into the ED with a medial dislocation of his elbow. The physician tried to reduce the dislocation but failed. She did not use any anesthesia during the procedure. How should I report this encounter?


Minnesota Subscriber


Answer: If the physician failed to reduce the injury, you will have to code for a reduced service and include a modifier.

On the claim:

- report 24600 (Treatment of closed elbow dislocation; without anesthesia) for the elbow reduction.
- attach ICD-9 code 832.03 (Dislocation of elbow; closed; medial dislocation of elbow) to show the reason for the reduction.
- append modifier 52 (Reduced services) to 24600 to show that you are not reporting a fully successful reduction. Of note: For PR reasons, many groups decide not to bill for painful procedures that were not fully successful.
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