FOS Coding Corner

Coding Corner Sponsored by Karen Zupko & Associates, Inc.

These Frequently Asked Questions are provided to assist you with common orthopaedic coding issues. Check back monthly for updated topics.

This Month's Topic:
Coding Existing Problem and New Problem on Same Visit

	Our physician recently saw a patient in the office for evaluation of an existing problem. During the same visit, the patient had complaints of a new problem. The physician thinks it is appropriate to report an established patient visit (99213) for the old problem and a 99244 (consultation) for the new problem. Is this correct?
	Only one E&M service may be reported per patient encounter. Report the appropriate E&M service based on the reason for the visit. If this patient was seen in consultation (9924x) report the consultation service for the reason for the visit. If the patient is an established patient and is not seen at the request of a physician for the new problem, report only the established patient visit code.

	Our surgeon recently saw a patient during the post op period for an unrelated problem. The patient was scheduled for their normal post op visit and during that time the physician evaluated a new problem. On the encounter form, the physician circled 99204 and the 99213-24. Is this correct? I did not think you could report two E&M services on the same day.
	The physician is correct in circling both services. Since the patient returned for their normal post op visit, it is important to record this in the practice management system. CPT code 99024 is never sent on a claim form to the payor. The staff should enter 99024 linked to the diagnosis for the surgical procedure into the system, but do not send it on the claim form. The 99213-24 (assuming this is correct level/category) is entered and sent to the payor with the modifier 24 linked to the new problem.

Coding Corner Archive

Just click on a topic below to view the discussion:

CX-rays and "minimum views" (May 2007)
CPT Code Usage at the Beginning/End of a Year (January 2007)
Code for Core Decompression of the Hip (November 2006)
Hallux Valgus with a Chevron Metatarsal Osteotomy (August 2006)
Removal and Re-insertion of Spacer (May 2006)
Posterolateral Fusion L1-L5 (April 2006)
Modifier 62 (October 2005)
Coding Arthroscopic Elbow Surgery (July 2005)
Visit Included in Global Surgical Package or Not? (May 2005)
Cortizone injections (April 2005)
Athletic Trainers and Incident-To Physical Therapy (March 2005)
Coding for Range of Motion, 95851 (February 2005)
Conscious Sedation—Can I bill or not? Will the payors reimburse me? (January 2005)
New vs. Established Patient (December 2004)
Consults vs. IP Admission (November 2004)
Skeletal Traction Application Prior to Definitive Fracture Management (October 2004)
NPPS as Assistants at Surgery (September 2004)
Minimally Invasive Procedures (August 2004)
Modifier 51 versus 59 (July 2004)

Send an Issue or Question for Future Discussion

Email your orthopaedic coding issues and questions to fraser@fos-society.com