Orthopedic Coding Alert

Question: Our orthopedists often give patients warfarin following hip and knee replacement surgery. We usually charge for a nurse's office visit (99211), along with the lab procedures that we perform to test the patient's blood. Are we coding these visits accurately?

New Mexico Subscriber

Answer: You should report only the lab tests that you perform and not the nurse's E/M code, because the E/M services are included in the surgery's global period. If, for instance, you administer a fingerstick and perform a prothrombin time test, you should report 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick) and 85610 (Prothrombin time). Match these to the appropriate ICD-9 codes, such as V58.61 (Long-term [current] use of anticoagulants).

If the nurse performs an additional patient evaluation (such as checking the surgical wound), you should include that as part of the patient's global surgical period following the joint replacement.