Orthopedic Coding Alert

When it comes to fitting and dispensing orthotics, you should live by the "less is more" coding philosophy. Despite the wide range of orthotics fitting, handling and checkout codes, you should not report every code in this series for each patient.
 
Suppose your orthopedist or podiatrist sees a patient who has a leg-length discrepancy as a late effect of an open, segmental tibial fracture (736.81, Unequal leg length [acquired]; and 905.4, Late effect of fracture of lower extremities). He performs a level- three E/M service and a biomechanical range-of-motion exam, and then fits the patient for an ankle-foot orthosis. Nine days later the patient returns to the office, and the physician shows her how to wear her new orthotic and remove it when necessary.
 
The practice vastly overcodes the service by reporting the following codes for the first visit:
 
99213 - Level-three established patient office visit
 
95851 - Range-of-motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)
 
29799 - Unlisted procedure, casting or strapping
 
A4580 - Cast supplies (e.g., plaster). The practice also reports these codes for the second visit:
 
99002 - Handling, conveyance, and/or any other service in connection with the implementation of an order involving devices (e.g., designing, fitting, packaging, handling, delivery or mailing) when devices such as orthotics, protectives, prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician
 
97504 - Orthotic(s) fitting and training, upper extremity(ies), lower extremity(ies), and/or trunk, each 15 minutes
 
97703 - Checkout for orthotic/prosthetic use, established patient, each 15 minutes 
 
L1980 - Ankle-foot orthosis (AFO), single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar "BK" orthosis), custom fabricated. "This practice seems to be grossly over-reporting the procedures they performed for the orthotics fitting and dispensing," says Ken Robertson, who bills for three podiatrists in Atlanta. Reporting orthotics codes can be very complicated, but submitting twice the appropriate number of codes isn't a good substitute for accuracy. Report E/M, Not 95851, for First Visit First, the practice reported both 99213 and 95851, but the National Correct Coding Initiative (NCCI) bundles 95851 into the E/M codes. Also, the November 2001 CPT Assistant advises, "The testing would be included as part of the physical examination, one of the key components used to determine the level of E/M service."
 
The practice should pare down its claims considerably by reporting 99213 for the initial E/M visit, but not 95851 for the range-of-motion exam.
 
If your orthopedist applied the plaster cast to create an orthotic mold, you should also exclude 29799 from your claim. You should report this code only if you apply the cast to immobilize [...]