Wiki ED Separate procedures

Mount Sinai, NY
Best answers
Hi Everyone,

I am hoping someone can shed some light on a little issue I am having.

A patient comes into the ED with a fractured wrist. Dr examines and decides that he will do a reduction. Do you code the E/M level with a modifer 57 since it is a 90 post op or do you code it with a 25?

Also I read that a modifier 54 would be appropriate on the procedure itself. If this is correct, would I bill an E/M level along with it? And if so, what is the correct modifier to use?

Andrew M.
Looks like Correct Modifiers

57 would be the correct modifier in the case of a fracture reduction for the reason you give. And 54 would be correct as well, unless for some reason (rural ED), the ED doc was also doing all of the follow up care which is usually very unlikely. Remember even with a 57 the documentation has to support the E&M Level.
Good job.

To clarify

Just to clarify .... the -57 modifier goes on the E/M service. The -54 modifier goes on the fracture care code (unless, of course, the ED physician is going to provide the follow-up care during the 90-day global).

Hope that helps.

F Tessa Bartels, CPC, CEMC