Medicare Compliance & Reimbursement

Question: A parent brings her 14-year-old son to the emergency department with an injured right finger he suffered during a skiing accident. The physician diagnoses a closed metacarpal fracture, which he resets using manipulation and places in a plaster cast. He tells the parent to follow up with an orthopedist for continuing care. Notes indicate a level-three pre-procedure E/M service. What modifier should I append to the E/M code? Answer: Many private payers (and Medicare) want you to append modifier 57 (Decision for surgery) to the E/M service code each time the physician provides definitive fracture care and an E/M during the same encounter. For these payers, report the following: 26605 (Closed treatment of metacarpal fracture, single; with manipulation, each bone) for the fracture care Modifier 54 (Surgical care only) appended to 26605 to show that you are coding the procedure only and not coding for the follow-up care 99283 [...]