Question Fracture care in the ED...


Paso Robles, CA
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It confuses me… a lot! I’ve done research and sometimes the answers are contradicting on this forum and on the internet. =(

Two questions here-

When the ED doctor preforms reductions, splinting of displaced and non-displaced fractures, etc., I’m not always sure if I code only for the splint or only for the procedure.
Most often, the ED Dr. says the patient needs to f/u with ortho in 3-5 days. Splint vs Procedure?

And then there is this one:

Open displaced comminuted fracture of the distal aspect left tibia.
Displaced comminuted fracture of the distal aspect left fibula.
Large wound to left medial ankle with tibia exposed.
Wound washed thoroughly, fracture reduction: left distal tibia, splint applied, reduction confirmed with x-ray. Transferred to a higher level of care.
Procedure with modifier -54 ?? CPT 27825 ? * On this forum, I read it would be a “closed reduction” in the ED. ??

Thanks!! *I only code for facility


True Blue
Salt Lake City, UT
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The cast/splint is always included in the initial treatment of a fracture. So you can bill for the reduction. I heard somewhere that you can have a closed reduction of an open fracture so 27825 is probably good. But the most important part for you is adding the -54 modifier to the reduction code. Without it the ED physician will be given the full 90 day global value and the next doc who has to complete the reduction won't get paid, because the ED doc did.