Orthopedic Coding Alert

Question: I've been submitting 99241-99245 when one of my surgeons does a consultation in the emergency department (ED), but I'm getting denials for place of service. How should I code these consultations? Hawaii Subscriber Answer: CPT states that 99241-99245 (Office consultation for a new or established patient ) are for "office or other outpatient consultation," so they are not limited to office visits. The description at the beginning of the section reads, "including hospital observation, home, domiciliary, rest home, custodial care, or emergency department." Perhaps the carrier denying the claims has an internal policy that limits the place of service that can be reported with these codes, which would be an incorrect interpretation of CPT guidelines. You should contact the payer's provider relations department to resolve this issue. Answers to You Be the Coder and Reader Questions were provided by Heidi Stout, CPC, CCS-P, coding and reimbursement manager for University Orthopaedic Associates in New Brunswick, N.J.