January 9, 2020 Question: Is it appropriate to report CPT code 28645 for both traumatic and non-traumatic dislocations? Answer: Yes, CPT code 28645 (Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed) may be reported whether the nature of the dislocation is traumatic or non-traumatic, as long as the dislocation required an open...
December 19, 2019 Question: We have an osteoporosis clinic where our providers see patients on referral. Many times this referral comes from our own colleagues after the patient is seen through the ED for a fracture. A consult and global fracture care is billed in the ED by the first provider, and the referral is...
December 5, 2019 Question: We have a new pediatric orthopaedic surgeon who has joined our practice. He recently performed periacetabular osteotomies for hip dysplasia. He wants us to report CPT codes 27228 and 27146 x3 for this procedure based on information he received during his fellowship training. We have told him that we must report...
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...
