ED Coding and Reimbursement Alert

Question: An ED patient fell and broke his nose because he lost consciousness (syncope). Can we bill the broken nose as 21315 (closed treatment of nasal bone fracture; without stabilization) in addition to the E/M visit?

Edward Lane
Kino Community Hospital, Tucson, Ariz.

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: In this case, its certainly appropriate to code for an E/M level because the physician will have to determine why the person passed out. Depending on the documentation, you could possibly code a level four (99284) or five (99285) because syncope can be very difficult to assess.

If the doctor discovered the nasal fracture during the exam, its fine to code for a procedure related to this finding. However, from your description, correct coding for the broken nose would more likely be 21310 (closed treatment of nasal bone fracture without manipulation) rather than 21315. The reason for the alternate code is based on the procedure. Its like the cart before the horse. The physician would first pop the broken nose into place (manipulation) and then somehow brace the nose to keep it in place (stabilization). Its highly unlikely that a physician would stabilize the nose without manipulating it first. The physicians work in treating the fracture could justify a separate charge. But thats a case-by-case decision because often the EDs involvement is nothing more than giving the patient an ice pack until someone else follows up.