Orthopedic Coding Alert

Orthopedic emergencies require immediate intervention normally within six hours. Beyond this time the patient is at risk for potential problems due to poor vascularity to the joint, infection, sepsis, or neural problems. On the CMS 1500 the procedures should be indicated as an emergency for the following: open fractures, dislocations, septic joint, compartment syndrome, neurovascular injury, and vascular injury. Indicating the condition as a true emergency (EM) will allow payment for payers out of network (OTN) or Medicaid policies as the circumstances would not allow standard policy protocol.