Wiki Closed Reduction

[susan.tower@martinhealth.org]

Need help figuring out how to put charges and code an ED account where the patient had a reduction attempted in the ED. Because it did not work a ortho Dr was called in and the patient was taken to the OR for the reduction.

I am getting an edit that we can not charge/code for both in the same day.

Any suggestions would be greatful.

 

[jimbo1231]

E&M

Susan,

Since the patient was moved to the OR, the definitive fracture treatment was done there not in the ED. If you tried the 52 modifier with the fracture it probably kicked because in the case it's not a reduced service but no restorative fracture care.
This would more likely be coded a 99284 depending on documentation. And if the physician applied a short arm splint in the ED, that would also be coded.

Jim

 

[OCD_coder]

If I am understanding the scenario in the posting correctly, you are billing the facility side for the ED and hospital. Under Medicare's NCCI guidelines for sequential procedures rules:

A failed procedure followed by a more extensive procedure should not be reported separately.

http://www.cms.gov/Medicare/Coding/...loads/ncci_correspondence_language_manual.pdf