Coding Coaches
Call Coverage: Return to OR
Question: I understand the E&M scenarios so let me throw in another type of call coverage relationship. Recently, I returned a patient to the OR for the physician I was covering; the patient had dislocated their hip after a hip arthroplasty. I reported CPT code 27266 without any modifiers; as I now understand the E&M rules I am wondering if I should have modified the code when I reported to the payor.
See the answer at www.karenzupko.com!
New or Established Patient
Question:
I am new to Orthopaedics. I am in a practice that employs a joint specialist, spine specialist and a pediatric orthopaedic surgeon in addition to general orthopaedic surgeons. Do the new patient rules apply to each of these specialties? For example, a patient is first seen by the general orthopaedic surgeon and then is sent to the spine surgeon. Is the spine surgeon able to report a new patient visit because he is a different specialty?
See the answer at www.karenzupko.com!
Bone Graft
Question:
My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision. The surgeon submitted CPT code 25431 alone. I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Shouldn’t we be able to report the bone graft in addition to 25431 because of the separate incision?
See the answer at www.karenzupko.com!
Question: I understand the E&M scenarios so let me throw in another type of call coverage relationship. Recently, I returned a patient to the OR for the physician I was covering; the patient had dislocated their hip after a hip arthroplasty. I reported CPT code 27266 without any modifiers; as I now understand the E&M rules I am wondering if I should have modified the code when I reported to the payor.
See the answer at www.karenzupko.com!
New or Established Patient
Question:
I am new to Orthopaedics. I am in a practice that employs a joint specialist, spine specialist and a pediatric orthopaedic surgeon in addition to general orthopaedic surgeons. Do the new patient rules apply to each of these specialties? For example, a patient is first seen by the general orthopaedic surgeon and then is sent to the spine surgeon. Is the spine surgeon able to report a new patient visit because he is a different specialty?
See the answer at www.karenzupko.com!
Bone Graft
Question:
My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision. The surgeon submitted CPT code 25431 alone. I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Shouldn’t we be able to report the bone graft in addition to 25431 because of the separate incision?
See the answer at www.karenzupko.com!
