ED Coding and Reimbursement Alert

Remember: Separate E/M almost a given on ED fracture fixes When your ED physician performs fracture care treatment, you-ll need to identify treatment type and scour the notes for evidence of manipulation in order to choose the right code. Also, you need to include the proper modifiers or you risk miscoding your physician's services. But if you answer these 4 questions when filing fracture care claims, you-ll be able to submit successful claims each time. Question 1: Is Treatment Open or Closed? The first thing you-ll have to decide when reporting fracture care is whether the ED physician performs open or closed treatment on the injury. There are separate CPT codes for each. Example: Let's say your physician treats a patient's radial shaft fracture. With this information, you can narrow code selection to three choices: 25500 (Closed treatment of radial shaft fracture; without manipulation), 25505 ( - with manipulation) or 25515 (Open treatment of radial shaft fracture, with or without internal or external fixation). But you won't be able to settle on a single code without first knowing the type of treatment the physician performs, confirmed Annette Grady, CPC, CPC-H, CPC-P, an independent coding consultant in North Dakota, during her recent Coding Institute teleconference "Crack the Fracture Code Billing Conundrum." The ED physician performs closed treatment "when the fracture site is not surgically opened (exposed to the external environment and directly visible)," reported Grady, who is also a former national board officer for the American Academy of Professional Coders (AAPC). The physician may or may not use manipulation or traction during closed treatments, she said. Open treatment occurs when "the fracture is both surgically opened and visible, or the fractured bone is opened remotely from the fracture site in order to insert an intramedullary (IM) nail across the fracture site," Grady explained. The physician may use internal fixation during open treatment. Remember: In order to code open treatment, the physician must make a surgical opening, which is not common practice for most ED physicians. Question 2: Did Physician Use Manipulation? For claims involving closed fracture care, check the operative notes for evidence of manipulation. Your code choice depends on it. Example: Let's say your physician performs closed treatment on a patient's radial shaft fracture. With this information, you can narrow code selection to two choices: 25500 or 25505 (- with manipulation), but you cannot decide on a single code without answering the manipulation question. Manipulation explanation: When your physician performs manipulation, he must move or adjust the involved bone(s) to improve their position or alignment, explains Robert LaFleur, MD, FACEP, of Medical Management Specialists in Grand Rapids, Mich. So let's say a patient presents to the ED with a metacarpal [...]