tci E/M Coding Alert - 2020 Issue Q4

Reader Question: Mend Your Understanding of This Facture Care Scenario

Question: Can we report an E/M code for comfort care if we confirm that fracture care was performed? Wisconsin Subscriber Answer: Yes, barring any payer-specific edits, you can typically report an E/M code (99281-99285) along with a fracture care code. However, keep in mind that you’ll need to append a modifier to the E/M code, and, in most cases, that will be modifier 57 (Decision for Surgery) instead of modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service)...

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