tci ED Coding & Reimbursement Alert - 2006 Issue 5

READER QUESTIONS: Separate E/M Possible When Fracture Patient Has Another Problem

Question: If a patient reports to the ED for treatment of a broken bone, can I ever report a separate evaluation and management service as well? Tennessee Subscriber Answer: It depends on whether you can prove the physician provided an E/M service significant and separately identifiable from the fracture care. Consider these examples of fracture care coding, one in which the physician provides separate E/M, and one in which the physician only treats the fracture.Example 1: An ED physician examines a patient who reports with a closed humeral shaft fracture. The patient is also complaining of a headache...

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