September 22, 2022 Question: After a recent audit and review with my physicians, they are telling me that they do not need to document a history and/or exam any more for the new and established patients. That is not my understanding. Answer: You are wise to ask because that’s not exactly true; we hear it...
September 8, 2022 Question: Our surgeon treated a patient who presented with an open fracture of the distal tibia and fibula. The surgeon performed an excisional debridement down to and including the bone removing devitalized tissue and gravel and other debris that imbedded into the open fracture site. Is CPT code 11012 reported twice for...
August 25, 2022 Question: I am new to an Orthopaedic practice where the coders do all the coding. The current coding staff is applying the 2021 E&M Guidelines to all encounters in the office; new, established and consultations (where the payors still recognize consultations). Is this correct? We did not do that in my former...
August 11, 2022 Question: Our surgeon saw a new patient in the office yesterday. His documentation supported reporting the E&M using time instead of based upon MDM. My question is about the time calculation. Today, he reviewed an MRI that the patient brought in this morning and he wants to add that time to his...
July 28, 2022 Question: A patient sustained an ankle fracture and a shoulder fracture and surgery was performed on same day by two different surgeons (partners) during the same surgical session. Dr. “A” performed the ORIF of the shoulder fracture and Dr. “B” performed the ORIF of the ankle fracture. Would they be considered co-surgeons?...
July 14, 2022 Question: I am a contracted physician with a group practice (Practice A) in our town. I have an opportunity to contract with another practice (Practice B) not in the same town, but near enough that my patients could see me in either location. My question has to do with the definition of...
June 30, 2022 Question: I heard someone say the 2022 CPT manual will be updated in July with new codes. I have never heard of this before. Is this a rumor or will there be a new CPT Manual released in July? Answer: No, there will not be any changes to the 2022 AMA CPT...
June 16, 2022 Question: What type of graft or fixation material is required to report open extra-articular knee ligament reconstruction code 27427? Our physician is listing “MCL repair” and “MCL reconstruction” within the same operative note. It first describes repair of the ligament using Suture Tape. In a separate paragraph the physician describes insertion of...
June 2, 2022 Question: We are looking at CPT code 0707T for reporting subchondroplasty in our practice. We have never billed a Category III code and do not know how to set the fee. Answer: Setting the fee for the Category III code will follow the same methodology as an unlisted procedure code. KZA recommends...
May 19, 2022 Question: We are an academic orthopaedic practice with an orthopaedic GME-approved residency program in a large metropolitan city. We were just informed we have been incorrectly reporting E&M codes 99202-99215 to Medicare since January 2022. We select the level of service based on MDM or time, as we understood this to be...
