tci ED Coding & Reimbursement Alert - 2000 Issue 11

Reader Question: Greater Tuberosity Fracture

Question: A patient presented to the emergency department (ED) with a fracture of the greater tuberosity of the humerus and anterior shoulder dislocation. The orthopedic surgeon was consulted after x-rays confirmed the diagnosis. One of the ED physicians assisted with the reduction of the dislocation. The procedure was performed in the ED after the orthopedist had ordered conscious sedation. Can I bill this procedure with the appropriate CPT code and modifier -81 to indicate minimal assistance of this closed procedure? If so, I will verify with the orthopedist whether or not to indicate manipulation of the greater tuberosity fracture...

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