Pediatric Coding Alert

Question: Our pediatrician treated a three-year-old patient for nursemaid’s elbow after he fell on the street while trick-or-treating during Halloween. Which procedure code represents this procedure, and which ICD-10 code should I report on this claim?

Answer: You’ll report the procedure with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). On the claim, be sure to link the correct diagnosis code to 24640 to represent the patient’s affliction. Under ICD-10, you need to know whether the left or right arm is impacted before you choose your code. You’ll report S53.031A for the initial encounter to treat nursemaid’s elbow of the right elbow, and S53.032A for the left elbow. 

Because these are ‘S’ codes from Chapter 19 of the ICD-10 manual, you should also report ‘V,’ ‘W,’ ‘X’ or ‘Y’ codes from Chapter 20 to describe “Occurrence, Activity and Place.”

You’ll typically be able to report a separate evaluation and management code along with 24640, assuming that the pediatrician documents an appropriate history, examination of the patient, and medical decision-making that he performed before treating the injury.

If the procedural notes justify a separate E/M along with 24640, be sure to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code. Optimal documentation would be to provide separate evaluation/management and procedure notes. Distinct diagnoses linked to each CPT^® code, although not absolutely necessary, would be best.