Category: CC-Orthopaedics


Medicare Incident-To Billing Rules

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 develop the plan of care him or her, and, on the next visit, the PA can implement the plan of care and bill Incident-To assuming the physician or another supervising physician is in the office?


Injection Code 96372, Is This Correct?

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

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 findings, pathology of the disease process and discussing operative versus non operative management. The patient has chosen to start first with physical therapy but understands that due to the pathology at this time, surgery may be required in the future.” The surgeon has stated that this visit should be based on time because there was no medical necessity to repeat all the history and exam information as nothing had changed since the prior visit. In looking at the note, I do not believe the documentation requirements are met to select a code based on time. Can you please advise?


Resident Services

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 Attending Physician was contacted, though the Attending did not see the patient in the ER. The resident documented the findings and discussion with the attending via the telephone; documented specific orders by the Attending for care provided while the patient was in the ER, including the admission to the Orthopaedic Service. The Attending Physician saw the patient the next day and documented the visit. My question is, can I bill for an E&M service for the telephone discussion with the Attending Physician even though the Attending did not see the patient in the ER? The Attending Physician stated that unless something has changed, the discussion with the resident is not a billable service for him.


Claw Toe

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

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 the sutures. Is this reportable? If yes, what CPT code would I use?


CMS Denials for CPT code 22633 and 63047

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.



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.

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