January 19, 2023 Question: I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in 2022 and now working on the tools. In 2022, I kept hearing that inpatient and outpatient consultation codes were being deleted. However, they are still...
Category: CC-Orthopaedics
Retinacular Repairs
December 15, 2022 Question: Our surgeon documented a repair of the patella tendon with repair of the medial retinaculum repair. The surgeon wants to code for the retinacular repairs and I can’t find a CPT code. Are you able to assist? Answer: Thanks for your inquiry. A retinacular repair is inclusive to other surgical repairs...
Secondary Payor Doesn’t Recognize Consultations
December 1, 2022 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
E&M Coding Based on Time
November 17, 2022 Question: Our physicians default to time for almost every office encounter. We are working with them on documentation and what work contributes to total time and what does not. They perform their own independent interpretation of X-Rays (we bill globally), perform injections, and reduce fractures in the office. They are counting the...
SI Joint Injection
November 3, 2022 Question: What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance. Answer: CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code...
E&M Coding Based on Time
October 20, 2022 Question: When choosing the level of E&M we are confused about the History and Exam. If we choose a level of E&M based on time, does this time count toward total time, or is it only time spent on MDM? Answer: When choosing a level of E&M based on time, CPT identifies...
Counting Laminectomy Levels
October 6, 2022 Question: I am confused and hoping you can clarify a coding question I have. I thought I understood how to report laminectomy levels, however, after recently reading an article in the AHA Coding Clinic HCPCS Volume 22, Number 2 Second Quarter 2022 publication, I doubt myself. The surgeon performs and documents a...
2021 Evaluation and Management Codes: Is a History and Exam Required?
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...
Excisional Debridement Two Fractures:
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...
2021 E/M Guidelines and Consultation Codes
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...