Orthopedic Coding Alert

The acute versus chronic decision is important for many reasons. For instance, some state health information regulations require an E code as the secondary diagnosis when acute injuries are reported, and certain drugs are approved only for acute or chronic conditions.

In addition, a patient encounter may qualify for a higher-level E/M code when the orthopedist treats several chronic conditions during the same visit. For instance, a low level of risk (often reported with levelthree codes, 99203 or 99213) in the E/M medical decision making (MDM) guidelines includes exams during which the orthopedist treats one stable chronic illness. A moderate level of MDM (relating to level-four codes, 99204 and 99214), however, involves treating two or more stable chronic illnesses.

Problem: This can put intense pressure on orthopedic practices that can't always categorize patients' injuries and conditions.