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Pediatric Coding Alert

Reader Questions:

Check If Exceptions Exist in Fracture Modifiers

Published on Thu Apr 01, 2010

Question: A parent brings her 14-year-old son to the office with an injured right finger he suffered during a skiing accident. He is an established patient. The pediatrician 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-two preprocedure E/M service. What modifier should I append to the E/M code?North Carolina SubscriberAnswer: 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 careModifier 54 (Surgical care only) appended to 26605 to show that you are coding the procedure only and not coding for the follow-up [...]
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