Understanding Treatment is Key to Correct Coding for Repair of Fractures and Dislocations
Published on Fri Oct 01, 1999
The first issue of ED Coding Alert (December 1998) covered the correct way to report ED physician treatment of orthopedic injurieswhen to use orthopedic codes vs. evaluation and management (E/M) codes.
However, when the ED physicians repair of a fracture or dislocation is reported with an orthopedic code, assigning the correct code is often a problem. For instance, the physician performs repair of a distal phalangeal fracture of a patients right index finger. Should the code assigned be 26750 (closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each); 26755 (with manipulation, each); 26756 (percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each); or 26765 (open treatment of distal phalangeal fracture, finger or thumb, with or without internal or external fixation, each)?
In most cases, the coder must discern which service was performed from the EDs documentation of the patient encounter. Even when the documentation is thorough, coders will often need a basic knowledge of some clinical terms to assign the correct code. What is closed treatment? What is open treatment? What services constitute manipulation or internal or external fixation? (For some basic keys to understanding clinical terms for ED orthopedic coding, see box on page 75).
Editors Note: There are many different orthopedic codes listed in the Musculoskeletal System subsection of the CPT Surgery section. In this article, we will cover some general areas. Before assigning a particular code, be certain that it indicates the specific service performed. If you are uncertain, please check with the ED group or ED physician reporting the service.
Documentation Yields Clues to Treatment of Dislocations
Simple dislocations are often treated in the ED, with more complex open dislocations being stabilized and sent to a specialist for treatment, says Kenneth DeHart, MD, FACEP, president of Care First Health Specialists, an emergency physician group in Myrtle Beach, SC, and chairman of the American College of Emergency Physicians(ACEP) advisory committee on coding and nomenclature. Typical procedure is closed treatment of a shoulder dislocation, code 23650 (closed treatment of shoulder dislocation, with manipulation; without anesthesia), he says. Manipulations of dislocations, rather than involving two or more pieces of broken boneas in fracture manipulationmostly involve popping the joint back into place. This is known as reducing the dislocation.
Coders should look for application of digital blocks (for finger and toe dislocations) and documentation of the reduction in the procedure note to apply an orthopedic code, notes John Stimler, DO, FACEP, a practicing emergency physician in Jacksonville, FL, and a past president of the Florida Chapter of the ACEP.
Also, look for dislocation and repair in the differential and final diagnoses, he adds. Although not very common, some open dislocations are reduced in the [...]
