Fracture and E&M charges on same day

We bill an E&M code(99203) with a new fracture and put a 57 mod on the 99203. We have never had an issue billing this way. We have never added the e&m charge if we were billing out "smaller" fractures(toes, fingers). Has anyone ever heard of any exclusions to the 57 mod rule in this case? Can we bill out for a fx finger or fx toe and an e&m charge w a 57 mod?

Aliza

E/M and Fx codes

The fracture code includes evaluating the injury site and proceeding to treatment. Anything above and beyond that requiring evaluation, can be billed as E/M code level (ex, co-morbid conditions or differential diagnosis requiring evaluation, testing). In this case the 57 modifier is appropriate on the E/M.
Modifier -57: An E&M service that resulted in the initial decision to perform surgery.• May be appended to E&M services that resulted in the initial decision to perform a surgery
Example: Code 99204-57 Office or other outpatient visit for the E&M of a new patient; 27814 Open treatment of bimalleolar ankle fracture (e.g. lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed.

Fracture and E&M charges on same day

But has anyone heard that billing both charges are based on the body part that was fractured? example-is there a difference btwn a toe and an ankle?