Wiki laceration/fracture

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millert

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I am having trouble coding cpt procedures when a patient comes in the ER with an open fracture to a finger and it is sutured and a splint applied for the fracture are both of these procedures codeable and if so is a modifier applied?
Thanks for all your help!:)
 
Fracture coding

It is my understanding that the initial splinting, casting or strapping are included with the fracture care code and should not be coded separately. Please see the subsection guidelines "Application of Casts and Strapping" in the CPT manual. This is in the Surgery/Musculoskeletal section.

If you are coding the open fracture CPT code (such as 26735), I would not code the suturing separately.
 
Code open fracture care with modifier -54 (surgical care only) if the patient will follow up with another provider (if coming back to the ED for suture removal no mod -54 and suture removal will be at no charge) OR code the suturing and splinting/casting with supplies (if following up with another provider and not returning to the ED).
 
Lac repair/open fracture

Did the MD do a reduction of the fracture?
If you have a lac repair of say 12001, the CCI edits eliminate your use of a splint code. Only, a 25 modidier is needed on the E/M code.

If you have a reduction code of 26725 you would apply the 54 modifier to this CPT and a 57 to the E/M code.

More information is helpful when asking question such as what codes are you using and whether or not this is a repeat visit.
 
CCI edit

We don't know what code was used for the open fracture/lac repair. If a volar splint was used (29125) this is included in the CCI edits with 12001 and cannot be used.

I agree, if a 29130 is used, it is not in the CCI edits with 12001 and can be used with a 51 modifier, unless this patient is Medicare then other rules will apply.

Not enough information to give a good answer to this question, there are many different answers applicable.
 
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