ED Coding and Reimbursement Alert

Question: A 36 year old patient presents to the ED with pain and inability to ambulate due to pain in his right lower extremity after a fall. The ED physician notes swelling and ecchymoses just above the patient's right ankle during a detailed exam (notes indicate a detailed history as well). He orders the patient to be medicated with intravenous Dilaudid and orders an x-ray of the ankle and tibia-fibula. The x-ray shows a moderately angulated fracture of the distal portion of the tibial shaft. After the patient receives moderate sedation, the physician manipulates the fracture and re-aligns the bones. A post reduction x-ray shows the bones to be well aligned, so the physician places the patient in a cast with instructions to follow up with an orthopedist. Notes indicate 22 minutes of moderate sedation time with a qualified independent observer monitoring the patient.What is the coding combination for this [...]