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How Do I Code This Multiple Fracture Accident Patient?

Posted on 24. Sep, 2009 by in Coding Challenge, Hot Coding Topics

Question: A 30-year-old female presents to a rural ED with several injuries after the all-terrain vehicle she was driving overturned. During a level-five ED E/M service, the physician diagnoses a fractured metacarpal shaft in her left hand and a fractured left femur. The ED physician provides closed manipulative treatment for each fracture. How should I code this scenario?

Answer: Report the most severe fracture first, and make sure that you append a surgical modifier to the treatment codes. To make things easier, we’ll list the appropriate CPT codes first, then the ICD-9 codes.
CPT coding: On the claim, report the following:

• 27502 (Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction) for the femur treatment

• 26605 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) for the metacarpal treatment

• modifier 54 (Surgical care only) appended to 27502 and 26600...

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