tci ED Coding & Reimbursement Alert - 2004 Issue 2

You Be the Coder: Watch Modifiers With Fracture Treatment

Question: Our ED physician reported evaluation and management code 99283-25 and 26720-54 for treatment of a proximal finger fracture. The diagnosis for the former was 959.9, and 816.00 for the latter. If the doctor didn't instruct the patient to follow up with an orthopedist, was he correct with these codes?Delaware SubscriberAnswer: This scenario raises several issues. Assuming that your physician performed a history and exam that went beyond the localized injury (including, for example, meds, allergies, past medical history, a neurovascular exam, and a screen for other injuries), then you are correct - a moderate-level E/M...

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