EM Coding Alert

Question: Notes indicate that the ED physician performed a level 5 evaluation and management (E/M) service for a patient that included a three-view femur X-ray. The final diagnosis was “femoral Fx, proximal end, neck.”

Then the doctor performed closed treatment of a femoral fracture, proximal end, neck without manipulation. How should I code this encounter?

New Mexico Subscriber

Answer: To determine which codes to report for this scenario, it’s a good idea to start with the E/M and then code the X-rays, followed by the surgery. Finally, select the ICD-10 coding.

E/M: Because you noted that the physician documented a level-five E/M visit, you’ll start with coding that part of the service with 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: comprehensive history; comprehensive examination; medical decision making of high complexity ...) for the E/M service.

Append modifier 57 (Decision for surgery) to 99285. The global period for the surgery is 90 days (major), so this is the right modifier for the E/M that led to the decision to operate.

X-rays: Choose from the following options:

Report 73552 (Radiologic examination, femur; minimum 2 views) for the X-rays. The side is not specified here, but append modifier RT (Right side) to 73552 for X-rays of a right femoral shaft fracture. Report 73552 for the X-rays with modifier LT (Left side) appended for X-rays of a left femoral shaft fracture.

Append modifier 26 (Professional component) to both instances of 73552 to indicate your physician is reporting only the interpretation and report, not the full global code. Keep in mind that the physician providing the interpretation and report is the one who should code for that service.

Fracture care: Report 27230 (Closed treatment of femoral fracture, proximal end, neck; without manipulation) for the fracture treatment.

Append modifier RT (Right side) to 27230 for treatment of a right femoral shaft fracture.

Append modifier LT (Left side) to 27230 for treatment of a left femoral shaft fracture.

ICD-10: Append one of the following diagnosis codes to 99205/99215, 73552, and 27232:

• S72.044A (Nondisplaced fracture of base of neck of right femur, initial encounter for closed fracture)
• S72.045A (Nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture)
• S72.046A (Nondisplaced fracture of base of neck of unspecified femur, initial encounter for closed fracture).