ED Coding and Reimbursement Alert

Question: The ED physician sees a patient who has just been in a minor car accident (she lost control while driving and her car hit a tree). After a level-four E/M, the physician diagnoses a closed ulnar shaft fracture. The encounter notes indicate that he applied a 4-inch ulnar gutter splint to the injury. Is this a short- or long-arm splint? Minnesota Subscriber Answer: The gutter splint is considered a short-arm splint. On the claim, report the following: - 29125 (Application of short-arm splint [forearm to hand]; static) for the splint application - 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; detailed examination; medical decision-making of moderate complexity) for the E/M - modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99284 to show that the E/M and fracture care were separate services - 813.22 (Fracture of radius and ulna; shaft, closed; ulna [alone]) linked to 29125 and 99284 to represent the patient's fracture - E815.0 (Other motor vehicle traffic accident involving collision on the highway; driver of motor vehicle other than motorcycle) linked to 29125 and 99284 to represent the cause of the patient's injury.