Orthopedic Coding Alert

Question: A cardiac surgeon recently called our orthopedic surgeon into the operating room during an open heart procedure. The cardiologist asked the orthopedist to consult because the patient's rib splintered when the cardiologist opened the patient's chest prior to surgery. Can we bill for an intraoperative consultation?

Indiana Subscriber

Answer: If the visit meets the consultation requirements (request for opinion, review of the patient's condition, and a written report back to the requesting physician), your practice can report an initial inpatient consultation code (99251-99255).

To bill a consult, your orthopedist must send the requesting physician a report. If the cardiologist simply calls your surgeon into the operating room and asks him to repair a fracture, you cannot report a consult and should bill the surgical procedure only (such as 21805, Open treatment of rib fracture without fixation, each).

If the orthopedist performs a true consult and then repairs the patient's fracture, you can submit both codes as long as you append either modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or modifier -57 (Decision for surgery) to the consult code.