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Fracture care w/ sedation

Maureen Posted Wed 22nd of May, 2013 14:45:44 PM

Patient has closed fracture of radius and ulna. EM level of 99284
ED physician performed IV sedation, and post reduction X-ray is satisfactory. ED does not indicate that a reduction was performed. Casting was done separately by ortho tech.
In addition to the EM, what orther CPT codes would be added?

SuperCoder Answered Tue 28th of May, 2013 16:46:36 PM

E/M With Fracture Care
Fractures are the result of high energy injuries and warrant a thorough evaluation of the mechanism of injury, distal neurovascular status, and a screening for other injuries. As such, an E/M will typically apply. Be sure to document a thorough H & P. These cases typically involve prescription drug therapy, and tend to be high level cases, often 99284 or above.

Splints
If the fracture care code is being reported then a separate splint code should not be added. However, if the ED physician applies a splint, but does not meet the requirement for definitive or restorative care, then the splint code would be reported. For instance, if the patient has a non-displaced distal radius fracture which is placed in a volar short arm splint in the ED, and the orthopedist will place a cast in several days, then the splint code should be reported.

Common splinting procedures performed by ED physicians include:
•Finger 29130
•Short Arm 29125
•Long Arm 29105
•Short Leg 29515
•Long Leg 29505

If I sedate the patient to reduce a fracture, or perform Moderate Conscious Sedation, should I report the fracture care codes that carry the term “with anesthesia”?

Although the CPT manual itself does not have a specific description of when to apply the “with anesthesia”codes, written correspondence from AMA personnel has stated that “with anesthesia” refers to procedures performed in the Operating Room. The additional significant RVUs applied to the codes carrying the term “with anesthesia” reflect the extra effort involved in the formal OR process such as stand by time for OR preparation, scrubbing, induction of anesthesia, and formal OR processes.

Is it acceptable to bill for x-ray readings if I am also providing fracture care?
Yes, as long as you have met the documentation requirements for the x-ray reading service there is no prohibition against the same physician billing for both x-rays and fracture care. CPT specifically lists the subcomponents that are considered bundled with surgical procedures which include local infiltration,metacarpal/digital block; radiology services are not listed as being bundled.

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