Wiki HELP! Attempted fracture reductions

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littlelora

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Pt was seen in the office by our sports med doc. He attempted to reduce a metacarpal fx under nerve block, but was unsuccessful. He asked the pt to return in 1 week where he again, under nerve block tried to reduce the fx but was unsuccessful again. Sports med doc referred to in house ortho surgeon, for surgery consult. Pt went to surgery 2 weeks after initial attempted reduction. How would you code the first two visits with the sports med doc? E/M visit only, or fx manipulation code with -53 modifier?

Any help is appreciated!!
 
Modifier 53 and/or 52 would not apply to this situation. I would think this would be coded 26605, the second procedure 26605-76 and -54 if his care was transferred. I look forward to others thoughts on this.
 
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Ok, I do agreee with the -76 and the -54, except, the ortho surgeon did an ORIF for the pt's surgery. Dont they have to be the same CPT code to bill the -54/55?
 
According to OPTUM 360, UNDERSTANDING MODIFIERS: "Modifier 76 is appended to a code when the same provider or other qualified health care professional performs the same service again, SOMETIMES on the same day. This modifier can be used whenever the circumstances warrant the repeat procedure."
I would be glad to forward in an email the documentation from same reference in regards to Modifiers 54, 55 and 56. I've found this publication very helpful!
 
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