November 29, 2018

Question:
Our physicians are asking us to report closed treatment without manipulation codes when their Advanced-Practice Provider evaluates a patient with a fracture in the ED, in preparation for definitive care to be done in the operating room the following day.  What services should be coded for the services rendered by the APP in this instance?

Answer:
The appropriate coding would include the proper E/M code which is supported by medical record documentation.  If the Advanced-Practice Provider applies a splint and appropriately documents this, then a splint application code is called for.  As this service is rendered in the hospital / ED setting, it would not be correct to include any supply codes since the facility pays for this expense.  This also assumes radiology interpretation is provided by the hospital, so no 7XXXX-26 would be billed by your physician’s NP or PA.  Of note, proper modifiers for this would include both a -25 and a -57 on the E/M code.  The -25 modifier protects the E/M from bundling with the splint application; and the -57 protects the definitive fracture surgery, which is to be done the following day.

*This response is based on the best information available as of 11/29/18.