Category: CC-Orthopaedics

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.

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?

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?

Our surgeon performed a bone marrow aspirate from the iliac crest when performing a spinal fusion. The surgeon gave me CPT code 38230, but I am wondering if this is correct. Can you illuminate this for me?

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.

Our surgeon documented a revision of an interbody fusion and wants to report 22849 for the removal of a cage and placement of a new cage. Is this an acceptable use of the re-insertion code?

Can I report a right meniscectomy and left diagnostic knee arthroscopy during the same session?

Our sports medicine surgeon performed a joint injection (20610) and ultrasound guidance (76942). What modifiers are needed to submit this code combination?