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

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 Humeral 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

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

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