ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a wrist injury. Notes indicate that following a level-three exam, the ED physician diagnoses a closed "snuffbox fracture" and personally applies a thumb spica splint. The physician then directs the patient to see an orthopedist for follow-up care. What is a snuffbox fracture, and how should I code this scenario? California Subscriber Answer: A snuffbox fracture is a break in the anatomical snuffbox, or radial fossa of the hand near the carpal bones -- with the scaphoid and trapezium bones forming the "box" floor. When your ED physician diagnoses this type of fracture, you should report a diagnosis code from the 814.xx series representing a carpal bone fracture. On your claim, report the following: - 29125 (Application of short arm splint [forearm to hand]; static) for the fracture care - 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused 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) appended to 99282 to show that the E/M and fracture care were separate services - 814.01 (Fracture of carpal bone[s]; closed, navicular [scaphoid] of wrist) appended to 29125 and 99283 to represent the patient's injury.