ED Coding and Reimbursement Alert

Question: A patient presents with a badly injured left ankle. During the course of a level-four E/M, the ED physician diagnoses a fracture dislocation of the ankle with some diminution of the pulses in the foot. The ED physician promptly reduces the dislocation to restore blood flow to the foot and calls in an orthopedist, who continues to treat the fracture in the OR. How should I report this scenario? Missouri Subscriber         Answer: You will be able to report an E/M code and a reduction code. Since the orthopedist performed the definitive fracture care, you should not report a fracture care code. On the claim, report the following: 27840 (Closed treatment of ankle dislocation; without anesthesia) for the reduction. 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M  modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99284 to prove that the E/M and reduction were separate services. Note: For Medicare patients, append modifier 57 (Decision for surgery) to 99284 instead of modifier 25. 837.0 (Dislocation of ankle; closed) linked to 27840 and 99284 to represent the ankle fracture.