EM Coding Alert

Question: After evaluating an established patient’s sprain of the medial collateral ligament (M23.52) of her left knee, the orthopedist recommended conservative treatment and decided to apply a derotation knee orthosis (brace) that is molded to her morphology. Can I report an E/M code for the visit, and what code would I report for the orthopedist applying the knee brace?

Georgia Subscriber

Answer: The CPT^® code you would use for the physician applying the brace is 29530 (Strapping; knee).

And yes, if the physician evaluated the patient’s knee and the service met the key components of an E/M service, which are patient history, physical examination, and medical decision making, and the documentation illustrates a significant and separately identifiable E/M service from strapping the knee. In this case, you could report the office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to show that the physician provided a separate service from applying the knee brace. Checking with the payer around the modifier usage is always recommended to see how they expect to see a claim such as this.