Revenue Cycle Insider

Question: A 5-year-old patient recently presented with a dislocated left elbow. After examination, the pediatrician confirmed the dislocation and moved the bone and ligaments back into place. I’m unsure as to how to code this procedure. Also, since the procedure was performed on the same day as the exam, should I append a modifier, too?

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Answer: This claim will require a diagnosis code, a procedure code, an evaluation and management (E/M) code, and a modifier to fully capture the visit.

Another common name for a dislocated elbow in a child is nursemaid’s elbow, and this is how it is found in the ICD-10-CM index, so you will code the injury as S53.03- (Nursemaid’s elbow). Because the dislocation occurred on the left side, you will add a 6^th character “2.” You will also need to add a 7^th character “A” to indicate this is the initial encounter and the patient is undergoing active treatment. This will give you code S53.032A.

Code the procedure itself with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). In this case, you’ll choose an appropriate E/M code as well from the 99202-99215 (Office or other outpatient visit …) code set for your claim, appending modifier 25 (Significant, separately identifiable evaluation and management service by the same provider on the same day of the procedure or other service).

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC