Orthopedic Coding Alert

Orthopedists sometimes need to report codes for miscellaneous procedures or supplies, so coders must know what type of documentation payers want and request extra-contractual coverage to pay for these codes.

Undefined procedures are a coding challenge for any medical specialty. Carriers often deny miscellaneous codes at first sight, perhaps only to pay on appeal, if then. Yet sometimes there just isnt a well-defined code to describe the service rendered, so CPT includes a Special Services, Procedures and Reports subsection (99000-99090), which is in the Medicine Section. The codes essentially describe extra work of a clinical or non-clinical nature that goes above and beyond what is included within global service and E/M codes. If there isnt a specifically defined code for a service, look under the 990xx series for a miscellaneous services code.

CPT defines these codes as adjunct to the basic services rendered. They are used for services rendered that the practitioner feels is a legitimate charge that falls outside of global coverage, or when no global care is rendered. The following codes from the 990xx series (miscellaneous services) of CPT can be used by orthopedists in varying degrees.

99000-99002 These codes are for the handling and/or conveyance of a specimen or other item (e.g., orthotic cast) to a laboratory or other location outside the physicians office. When there is no pick-up and delivery service available, and a staff member of the orthopedic practice gets in a vehicle and goes to pick up or drop off orthotic supplies, it is a billable charge. When working with blood tests, biopsies, etc., merely putting the sample in the drop box outside the door for the lab to pick up doesnt count. An on-duty staff member must do the transporting. The code will most likely be payable for practices in rural areas, where conveyance of the specimen or supply requires a significant time commitment by the staffer.

99050-99056 These codes are for services requested after office hours, at night, or on Sundays or holidays, or at a place other than the physicians office when service is normally provided in the office. As attractive as these may look, miscellaneous services codes such as 99050 (services requested after office hours in addition to basic service) are unlikely to bring extra reimbursement, explains Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. For instance, with emergency services, these will be recognized only if the physician had to drop everything to treat the patient and it completely disrupted the practice, Callaway says. Coding for after hours, overnight and off-location services might be useful over the long term, if the physician wants to illustrate the real cost of services to third-party [...]