tci ED Coding & Reimbursement Alert - 2010 Issue 3

You Be the Coder: Pay Attention to Payer on Fracture Modifiers

Question: A patient reports to the ED with an injured right finger he suffered during a skiing accident. The physician diagnoses a closed metacarpal fracture, which he resets using manipulation and places in a plaster cast. The physician tells the patient to follow up with an orthopedist for continuing care. Notes indicate a level-four pre-procedure E/M service. What modifier should I append to the E/M code?North Carolina SubscriberAnswer: Many insurers will want to see modifier 57 (Decision for surgery) on the E/M. There are exceptions, however.Medicare, and a number of private payers, prefer modifier 57 each time...

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