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Comprehensive Guide to Musculoskeletal Injuries Billing

Learn the importance of documenting and coding fracture care and moderate sedation for optimal reimbursement. Understand RVU values and guidelines for various musculoskeletal procedures.

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Comprehensive Guide to Musculoskeletal Injuries Billing

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  1. Musculoskeletal Injuries Larry Halem MD, CPC VEP Regional Productivity Director

  2. E+M Levels Level 1 (99281): 0.6 RVU Level 2 (99282): 1.17 RVU Level 3 (99283): 1.75 RVU Level 4 (99284): 3.32 RVU Level 5 (99285): 4.9 RVU

  3. Moderate Sedation • The importance of billing moderate sedation is the length of time • Greater than 10 minutes minimum. • Time begins from administration of medications to when you leave the room • You must also document if you are performing the procedure and the sedation or just the sedation alone

  4. Moderate Sedation • If you perform the procedure and sedation: • Moderate sedation less than 5 year: 0.67 • Moderate sedation greater than 5 year: 0.35 • Each additional 15 minute block: 0.31 • If someone else performs the procedure while you perform the sedation: • Moderate sedation less than 5 year old: 2.63 • Moderate sedation greater than 5 year: 2.15 • Each additional 15 minute block: 1.63

  5. Fracture care • Documenting care of the fracture is important • A complete ICD-10 diagnosis is important to code appropriately • Manipulation is a key component to fracture care and the number of RVU’s generated • Follow up for your fracture must be greater than 48 hours to get reimbursed for the care you provided • This is the preoperative portion of the patient’s care

  6. Fracture care • Clavicle Fracture • Without manipulation: 0.63 • With manipulation: 0.94 • Humeral Fracture • Without manipulation: 0.87 • With manipulation: 1.2

  7. Fracture care • Radial shaft or radial/ulnar shaft fracture: • Without manipulation: 0.71 • With manipulation: 1.3 • Distal radius fracture: • Without manipulation: 0.8 • With manipulation: 1.3

  8. Fracture care • Metacarpal fracture (coded based on each bone): • Without manipulation: 0.7 RVU • With manipulation: 0.8 RVU • Finger Fracture: • Without manipulation: 0.5 RVU • With manipulation: 0.8 RVU

  9. Fracture care • Ankle Fracture (specify area of ankle being reduced): • Medial malleolus: • Without manipulation: 0.86 RVU • With manipulation: 1.2 RVU • Lateral malleolus: • Without manipulation: 0.81 RVU • With manipulation: 0.85 RVU

  10. Dislocations TMJ dislocation: 0.92 Elbow dislocation: 9.49 Shoulder dislocation: 8.2 Nursemaid elbow: 2.45 Finger dislocation: 7.2 Patella Dislocation: 9.4 Ankle Dislocation: 10.4 Toe Dislocation: 2.5

  11. Splints • You can only bill for splints that are made and assembled in the ER. • Document who applied the splint (some insurances will only pay if physician applies) • Document the splint material • Note must document neurovascular status after splint applied • Ace wraps, pre-made wrist splints, buddy taping, and knee immobilizers can no longer be billed

  12. Splints Finger splint: 0.82 Short arm splint: 1.13 Long arm: 1.71 Long or short leg: 1.43

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