New vs. Established Patient

May 26, 2016 Question: If I see a new patient and during that visit I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid? Answer: You determine during the evaluation that the patient would need surgery the same or next day for a major procedure (90 day global), append Modifier 57…


Source for a Consult

May 12, 2016 Question: What is an appropriate “source” for a consult? I asked at a recent workshop and the instructors did not have an answer. Answer: The guidelines for a consultation (inpatient or outpatient) must be requested by a physician, or qualified non-physician practitioner.  Guidelines are not clear regarding individuals who may be considered an appropriate source, but some likely…


Synovectomy Coding

April 28, 2016 Question: Since January we have not been able to get code 29875–59 paid. All of our claims are coming back bundled to code 29880. I have submitted the operative reports showing that it was a separate procedure, performed in a separate compartment however our appeals are also being denied. How do you recommend getting the claims…


Scoliosis Screening

April 14, 2016 Question: How do you report screening for scoliosis when the patient is sent by the school nurse or the pediatrician but, after the examination, there is no scoliosis identified? Answer: Z13.828 Encounter for screening for other musculoskeletal disorders is used to report this service. *This response is based on the best information available…


Meniscal Tear Coding

March 31, 2016 Question: If a patient presented with symptoms of a meniscal tear in the right knee, but the type and location were not known without an MRI, would it be correct to report an “unspecified” code for right meniscal tear? Answer: Yes, it is correct to report the unspecified code (S83.206A Unspecified tear of unspecified meniscus,…


Scoliosis Screening

March 17, 2016 Question: How do you report screening for scoliosis when the patient is sent by the school nurse or the pediatrician but, after the examination, there is no scoliosis identified? Answer: To report this service use: Z13.828    Encounter for screening for other musculoskeletal disorders *This response is based on the best information available…


Corpectomy or ACDF?

March 3, 2016 Question: Our orthopaedic spine surgeon recently attended a presentation sponsored by a vendor other than your firm. The surgeon returned to the office and was told that he could bill a corpectomy code in the anterior spine if he documented, “scraping or smoothing of vertebral endplates.” He told me we had missed out on a lot of…


Is Unspecified Sometimes the Correct Option?

February 18, 2016 Question: If a patient presented with symptoms of a meniscal tear in the right knee, but the type and location were not known without an MRI, would it be correct to report an “unspecified” code for right meniscal tear? Answer: Yes, it is correct to report the unspecified code (S83.206A Unspecified tear of unspecified meniscus,…


ICD 10: Aftercare Z Codes or 7th Character Code?

UPDATED February 4, 2016 Question: Patient has been seen in office during the global period after a rotator cuff repair for a sprain. No X-rays were taken. Internally we will record 99024. Would we assign Z47.89 or the sprain code to 99024? Answer: Thanks for your inquiry as your question gives us an opportunity to address documentation requirements and…


Lysis of Adhesions In the Shoulder

January 14, 2016 Question: We are having a debate in our office we hope you can help unravel. We want to report CPT code 29827 and 29825 together but our Coding Companion states that they are inclusive to each other and are bundled. Our surgeon is questioning the accuracy of this information. Answer: Your surgeon is correct…


Therapy Services

12/03/15 Question: We have a massage therapist employed in our office who is being supervised by our physical therapist. Our question: when we bill to Medicare, does the supervising therapist have to sign the massage therapist’s notes agreeing with the care provided that day and the plan of care? Answer: Therapy services performed by a massage therapist are…


Incident-To or Not?

November 5, 2015 Question: A physician assistant sees a Medicare patient in the emergency room independently. Can this visit be billed under the name and NPI of her supervising physician who did not see the patient? Answer: No, Incident-To services do not apply to hospital-based services, nor do they apply to new patients or patients with new problems….


Meniscectomy vs. Meniscal Repair

October 22, 2015 Question: Can you please clarify how to report the following procedure: The surgeon documented medial meniscal repair followed by a medial meniscectomy, both performed in the right leg. There are NCCI edits between the two codes showing 29881 payable and 29882 with a Column 2 edit. Do we code the repair or the meniscectomy since both…


Infected Knee

October 8, 2015 Question: Will you please direct this question to Mary LeGrand? I was consulted to evaluate a patient to rule out a septic knee. I saw the patient in the morning and aspirated the joint; the fluid was cloudy and sent to pathology. Later that day I was notified of an increased cell count and decided to take the…


Medicare: Debridement Services in the Shoulder

September 24, 2015 Question: We attend courses and receive education from KZA consistently on orthopaedic coding. Our practice recently hired a new billing manager and she states that the information we have been given is incorrect for Medicare related to arthroscopic debridement services. The billing managers external resource told her that 29822 or 29823 can be reported…


Dry Needling

September 10, 2015 Question: We are receiving conflicting information on the correct coding for a “dry needling” procedure. Is it possible that Mary LeGrand can answer this question for us? Answer: Thank you for reaching out to KZA for your coding needs. We are not surprised that confusion exists related to this procedure. The correct code for…


Can Physical Therapy Services Be Reported Incident-To a Physician Assistant?

August 27, 2015 Question: I am a Physician Assistant and I have a question about code 97110 and reporting services to Medicare. Can I report CPT code 97110 to Medicare under my name and NPI if I evaluate and develop a rehabilitation plan of care for a patient and the medical assistant in our office performs the exercises and documentation? Answer: No, Medicare does…


Different Specialties, Same Tax ID

August 13, 2015 Question: Can you help clarify the new patient rules related to multiple specialties in the same group practice? If we have different specialties (e.g., Pain Management, Podiatry, Rheumatology, Orthopaedics) can we charge a New Visit code when the patient is seen for the first time by a physician in a different specialty in the practice? Answer:…


Cast Changes During the Global Period

July 30, 2015 Question: We have not been billing for cast changes during the global period, but have recently been told we should be reporting this service. In our orthopedic physician practice, on occasion a patient will require a cast change (for various reasons). If the physician orders the cast change and is present in the office during…


New or Established Patient Visit?

July 16, 2015 Question: If a patient presents as a new patient visit and the surgeon reports an injection only, can the surgeon report a new patient visit when the patient returns for the follow up visit? Answer: No, the surgeon had a face-to-face encounter with the patient to perform the injection; thus, the follow up visit within the three year…


CPT or HCPCS Tool?

July 2, 2015 Question: We have recruited a new hand surgeon and she frequently applies aluminum finger splints which are molded by the surgeon or her medical assistant. Can we report CPT code 29130 for the application and molding of this splint? Answer: Thanks for this great question! The application of the splint code 29130 is not…


Medicare Incident-To Billing Rules

June 11, 2015 Question: We have a new PA in our office and we want to make sure we are billing correctly when we bill for his services Incident-To the physician. Am I correct to assume that when a new Medicare patient is seen in our office that the physician has to see the patient, examine the patient, and…


Injection Code 96372, Is This Correct?

May 21, 2015 Question: I am new to orthopaedic coding, having just left a Family Practice group after many years. The surgeon said he did an injection to the flexor tendon sheath of the right index finger. I want to verify that CPT code 96372 is correct for the injection. I am very familiar with reporting the J codes for the drugs….


E&M Selection Based on Time

May 7, 2015 Question: Our surgeon saw a patient in the office following a shoulder MRI. In the visit, the surgeon documented, “I had a very long face-to-face discussion with the patient today regarding their shoulder MRI. I spent over 20 minutes in the exam room discussing the results of the scan, reviewing the MRI with the patient, discussing the…


Resident Services

April 23, 2015 Question: We are in an academic setting and I have a question about a specific service performed when a resident was involved on a Medicare case. I was reading notes for a patient who presented to the emergency room (ER) and was admitted to the Orthopaedic Attending physician’s service. The notes by the resident in the ER indicate that the…


Claw Toe

April 9, 2015 Question: We are having some debate about whether CPT code 28285 (hammertoe repair) would be appropriate for fusion of a claw toe? The claw toe is the DIP joint; the hammertoe is the PIP joint. However, code 28285 does not specify which interphalangeal joint is corrected. Should we report 28285 or an unlisted code?…


Suture Removal

March 26, 2015 Question: Our surgeon saw a patient in the ER for a fracture and reported the global fracture code. The ER physician had repaired a separate wound laceration at a different site prior to our surgeon arriving in the ER. The patient is now being seen in the office and the surgeon evaluated the wound area, and removed…


Bone Marrow Aspirate for Grafting

March 12, 2015 Question: Our surgeon performed a bone marrow aspirate from the iliac crest when performing a spinal fusion. The surgeon gave me CPT code 38230, but I am wondering if this is correct. Can you illuminate this for me? Answer: While the aspiration of bone marrow is separately reportable, CPT code 38230 is not the correct code. This…


CMS Denials for CPT code 22633 and 63047

February 26, 2015 Question: We reported CPT code 63047 with 22633 for a laminectomy, facetectomy, foraminotomy at the same level to Medicare. Both service were performed at L4-5 and well documented according to the CPT rules. We received a denial for CPT code 63047 as inclusive and have tried to appeal, but Medicare will not reverse the denial….



February 5, 2015 Question: We attended a coding course last week (non AAOS/non KZA) and were told that we could only report one unit of 20611 during an office visit because CMS had an MUE of “1” for this code. Answer: Ms. LeGrand explained that she had not heard of this and would research and post the answer….


Removal and Reinsertion of Cages

January 22, 2015 Question: Our surgeon documented a revision of an interbody fusion and wants to report 22849 for the removal of a cage and placement of a new cage. Is this an acceptable use of the re-insertion code? Answer: Great question and one that is not uncommonly asked in the Orthopaedic Coding courses presented by Mary LeGrand and…


Diagnostic Arthroscopy and Meniscectomy

January 8, 2015 Question: Can I report a right meniscectomy and left diagnostic knee arthroscopy during the same session? Answer: Yes, CPT code 29881 (meniscectomy) and CPT code 29870 (diagnostic arthroscopy) are reportable during the same operative session when they are independently performed on different knees. Use of modifiers may be payor dependent. According to CPT rules, you…


What Modifiers Are Necessary?

September 4, 2014 Question: Our sports medicine surgeon performed a joint injection (20610) and ultrasound guidance (76942). What modifiers are needed to submit this code combination? Answer: Thanks for your inquiry. The answer is dependent on the place of service. Modifiers are not required if the service is performed in the office. Append modifier 26 to CPT…


Partial Synovectomy with Other Knee Procedures

Question: Our surgeon performed lateral compartment meniscectomy and a medial compartment synovectomy indicating that both procedures were performed in different compartments of the knee. We billed CPT 29875 in addition to CPT code 29881 and received a denial as inclusive. Is this correct? Answer: Yes. Code 29875, which describes limited synovectomy, has a separate procedure designation. As such,…


Arthroscopic Excision of Distal Ulna

Question: Our surgeon performed an arthroscopic excision of the distal ulna and wants to report the open procedure code. I am telling him that we must use an unlisted arthroscopic code. Can you advise us? Answer: You are correct. There is no CPT code for the arthroscopic excision of the distal ulna. He can use the…


Bone Wax

Question: What is the CPT code for bone wax used to control bleeding at the surgical site? Answer: Thanks for your inquiry. Bone wax, filler, or any product used to control bleeding at the surgical site is inclusive to the surgical procedure and is not separately reportable.


Toradol Intra-Articular Injections

Question: One of my providers wants to use J1885 Toradol (ketorolac) and administer it into the shoulder joint using 20610 large joint arthrocentesis code. The physician states there have been studies that this is an effective use of the drug. Everything I have read about it states it is administered IM or IV using the CPT…


G0289 or 29877

Question: We performed a tricompartment chondroplasty on a Medicare patient. This was the only procedure performed. Do we report the G code three times or CPT code 29877? Answer: The correct code is 29877 and, as you note, it is only reportable one time per knee per operative session.


G Code Reporting

Question: We are a sports medicine practice (This said “patient” but that doesn’t make sense so I went with “practice.”) and frequently do chondroplasty and arthroscopic removal of foreign body procedures. Can you tell us which payers require us to report the G code? Answer: We cannot tell you what payors will require the G code, other than Medicare,…


Meniscal Trephination

May 15, 2014 Question: Our surgeon recently documented that he performed a trephination procedure on the meniscus to treat meniscal pathology. Is this coded as a meniscectomy or a meniscal repair? Answer: The procedure will be reported with an unlisted code. Report 27599 if an open approach is performed; report 29999 if the procedure is performed arthroscopically.


Place of Service

May 1, 2014 Question: We are in an orthopaedic practice that is attached to the hospital. On occasion our physicians will have a stable patient transported to the office for appropriate medical evaluation. We are seeing denials for invalid place of service and we are not sure what is wrong. We have submitted the claim with POS…


AC Dislocation

April 17, 2014 Question: I am looking for a CPT code for an arthroscopic repair of an acromioclavicular dislocation. I cannot find a code and am not sure how to report this procedure. Can you advise how to report this procedure? Answer: Assuming the documentation supports the service you describe, the correct code will be an unlisted arthroscopy, 29999….


Cast Supplies

April 3, 2014 Question: We attended a fantastic seminar presented by Mary LeGrand. During the discussion she told us that payment for the casts and splint supplies will be paid under the DMEPOS. Can you clarify this? Answer: Yes, and thanks for attending and your positive comments. Effective April 1, 2014 CMS will process payments for casts…


Palmar Fasciotomy

March 20, 2014 Question: Our surgeon wants to know if we can report CPT code 26040 multiple times per hand since there is not an add-on code like 26123 and 26125. Answer: Thanks for your inquiry. CPT code 26040, Fasciotomy, palmar (e.g., Dupuytren’s contracture); percutaneous is not reportable more than one time per hand. There is no…


Modifier 78 Global Period Payment

March 6, 2014 Question: If a Medicare patient returns to the operating room during the post-op period and we bill the claim with a modifier 78 is the claim payment reduced? Answer: Yes, Medicare will apply a payment reduction to the surgical CPT code for the unplanned return to the OR. While a payment reduction occurs, the global period does…


Shoulder X-Rays

February 20, 2014 Question: What CPT code do I report for a shoulder X-Ray when the surgeon documented that he ordered and interpreted four views of the shoulder and documents the specific views? Answer: You will report CPT code 73030 Radiologic examination, shoulder; complete, minimum of two views since this code describes a complete radiologic examination of the shoulder….


Intraoperative Monitoring

February 6, 2014 Question: When performing spine surgery and a physician’s assistant is assisting, can the PA bill for intraoperative monitoring? Answer: No, neither the surgeon or an assistant surgeon or even a co-surgeon may bill for intraoperative monitoring.


ER Discharge

January 23, 2014 Question: Our surgeon was called to the ER for a consultation. The patient was discharged from the Emergency Room. Can you tell us how to report this? Answer: The correct category of CPT code will be dependent on payor rules. According to the 2014 AMA CPT rules, the service is a consultation and the 99241–99245…


0334T or 27096?

January 9, 2014 Question: Could you please help with some confusion that happening as a result of the alert regarding 0334T, the Category III code that became effective for use July 1, 2013. Our doctors have been doing sacroiliac joint injections for Sacroiliitis and we have been reporting these injections as 27096 if fluoroscopic guidance is used…