ED Coding and Reimbursement Alert

Question:A 67-year-old female presents to the ED after falling off a three-step ladder. After a level 3 E/M service and review of radiographs, the physician determines that the patient sustained a non-displaced fracture of the distal left ulna. Due to the swelling, the physician applies a plaster molded splint for immobilization and protection of the fracture. The patient is then referred to an orthopedic clinic for follow-up treatment and casting in two days.Answer: You should code this scenario as a splinting procedure. On the claim:Report 99283 (Emergency department visit for the evaluation and management of an established patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of moderate complexity) for the E/M.Attach modifier 25 to 99283 to show the E/M and splinting were separate services.Report 29125 (Application of short arm splint [forearm to hand]; static) for the splinting.Attach ICD-9 [...]