Our surgeon recently saw a patient in the ER and placed skeletal traction to stabilize the fracture while the patient awaits surgery. Can we report E&M services during this time period?

The skeletal traction CPT code, 20650 Insertion of wire or pin with application of skeletal traction, including removal (separate procedure) has a ten day global period.

While the surgeon is waiting to take the patient to surgery, s/he has essentially staged this procedure. S/he is stabilizing the fracture while at the same time determined that the fracture needs additional surgery. Any E&M services during the global period would be related to the fracture and future management, and as such are bundled. The diagnosis has not changed, thus it would be inappropriate to report the E&M as an unrelated evaluation E&M (modifier 24).

If the patient returns to the OR during the ten day global period for the definitive management, append the modifier-58 (Staged or related procedure) to the definitive CPT codes.

Mary LeGrand, RN, MA, CCS-P
KarenZupko & Associates, Inc.