Orthopedic Coding Alert

Question: My physician wants to bill for the time she spends reviewing medical records from other physicians when a patient transfers care to our office. Is 99080 appropriate, or is there another code that would be more specific?
Florida Subscriber

Answer: No, 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) would not be correct. In fact, reviewing records is part of the E/M service under CPT guidelines.

Your physician can take credit for this work by documenting her review of the record and summarizing it. This increases medical decision making for the data component, which may allow for a higher level of service overall if the exam and/or history support that higher level.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.