Orthopedic Coding Alert

Many orthopedic practices see arthritic patients at various stages of their treatment. Depending on the severity of the arthritis and the services offered by the orthopedic practice, an arthritic patient may be followed on a long-term basis by the same physician or may be treated by many different providers in the practice, both physicians and nonphysician practitioners. Repetitive, long-term care such as this often results in missed opportunities to code for and obtain fair reimbursement.
 
Following the Patient  
The following case study illustrates how much care the arthritic patient may need and where coders should be alert to coding opportunities. Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., takes readers through a long-term plan of care for an osteoarthritic patient, in this case a 62-year-old male with symptomatic osteoarthritis of the right knee, 715.16 (osteoarthrosis, localized, primary; lower leg). 
 
Evaluations Are Made  
"Typically a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist," Stout says. The rheumatologist has been treating the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Due to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. 
 
The orthopedic surgeon (OS) evaluates the patient, takes and reviews x-rays in his office and determines that due to a deformity of the knee caused by long-term osteoarthritis, 736.42 (genu varum [acquired]), the patient is a candidate for a total knee arthroplasty.
 
Other treatment options are reviewed, including a series of Hyalgan injections, because the patient is reluctant to have surgery. The OS offers an injection of Celestone for short-term symptomatic relief. The patient accepts and an injection is given, but he defers any further decision until he has had time to consider each treatment option. "This is fairly typical," Stout says. "An orthopedic surgeon will list one or more alternatives to surgery, which patients often see as a 'last resort.' "
 
This initial meeting with the orthopedist is coded as follows:
  99204x-25 -- office consultation for a new or established patient ... The modifer -25 is appended to indicate that the injection was a separate procedure from the E/M (consultation) code.
  7356X -- radiologic examination, knee (depending on the number of views taken)
  20610 -- arthrocentesis, aspiration and/or injection; major joint or bursa
 
J0702 x 2 -- injection, betamethasone acetate and betamethasone sodium phosphate, per 3 mg (two units of Celestone).
 
 
Terry Fletcher, BS, CPC, CCS-P, an independent coding and [...]