Closed and Open Treatment for fractures

Was sure hoping someone can give me direction or guide me to find written documentation for the following scenario:

Pt. is seen in E.R. with ankle fracture & Ortho physician states & documents that swelling needs to subside in ankle for the patient can be taken to surgery.  He wants to charge for the E.R. visit and for closed treatment of the ankle fracture after stating & documenting the patient will go to the O.R. at a later date for an ORIF.  

To me, this is double I'm needing written documentation for this scenario.........

All suggestions/info is welcome!  TIA!


  • Did he do anything in the ER?  If so I would look at cast or splint application.
  • I attached some guidance that I reference often and it does state that if an ORIF is planned non-manipulative treatment should not be coded. If he saw the patient in the ER you should be able to bill an ER E&M code.
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