November 14, 2019 Question: We have patients who return to the clinic for results of MRI or other diagnostic tests. The physician performs a repeat exam, reviews the images, and makes a decision for surgery. We always code these as level four established visits because of the decision for surgery. Our question is, if the...
October 31, 2019 Question: We have a patient scheduled for manipulation under anesthesia for arthrofibrosis during the post-operative period for a total knee arthroplasty. The patient was informed prior to the TKA surgery that they may need to have the manipulation done post op. Is it appropriate to use modifier 58 for the manipulation because...
October 17, 2019 Question: We have joined a new health system and the coding staff members (new to orthopaedics) are removing all E/M-57 services when reported with a fracture manipulation code. The coding staff members are stating these are inclusive to the fracture, as the physician has to evaluate the patient to determine if the...
October 3, 2019 Question: Our surgeon performed an I&D of a hematoma in the same compartment as an anterior and lateral fasciotomy in the leg for compartment syndrome. I submitted a code for the I&D in addition to the fasciotomy code and the surgeon removed the I&D code, stating it would be inclusive to the...
September 19, 2019 Question: Our surgeons are harvesting adipose tissue and creating an injectable implant that they are injecting in the knee for treatment of osteoarthritis. We want to verify that our use of an unlisted CPT code is correct. We have some payors who do reimburse for this service; others require the patient to...
September 5, 2019 Question: Our local hospital employs Physician Assistants. When our doctors are on call for the ED, the hospital-employed PA will call our doctor for their opinion and advice after seeing and evaluating the patient. At times our physician will go to the ED, see the patient and perform surgery. The question my...
August 22, 2019 Question: A patient presents to the office who meets Medicare’s definition for medical necessity for routine foot care. Nails are noted to be elongated and thickened, and hyperkeratotic lesions are noted to be on the right plantar heel and right foot second metatarsal head. The podiatrist debrides all ten nails and trims...
August 8, 2019 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a “Qualified Resident”. Some physicians consider a resident qualified to assist day 1 of their residency rotation, while others consider only 4th and 5th year residents as qualified to assist. Can you guide us to documentation...
July 25, 2019 Question: Our surgeon performed a meniscectomy on a Medicare beneficiary. During the 2nd post-operative visit, the surgeon started a series of Hyaluronate injections in the operative knee for a diagnosis of osteoarthritis. The claim form was submitted with a modifier 79 and a diagnosis of osteoarthritis. Our Medicare carrier denied it as...
July 11, 2019 Question: What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code. Answer: Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806. ...
