Orthopedic Coding Alert

Question: When my physician sees patients in the emergency department (ED) should we always charge for a consultation or should we use the emergency department services codes (99281-99288)?

Kansas Subscriber

Answer: Consider the following examples on this complicated coding issue:

1. The ED physician contacts Dr. OS (orthopedic surgeon) to see a patient who has presented to the ED after falling on her outstretched left hand. X-rays have been taken and show a possible fracture of the distal radius. Dr. OS examines the patient, reviews x-rays and determines that the patient has a nondisplaced Colles fracture. The patients wrist is placed in a temporary splint. The ED physician discharges the patient with instructions to see Dr. OS in his office in 10 days for casting. Dr. OS dictates a consult report.

In this case, Dr. OS can report the appropriate-level outpatient consultation code (99241-99245) along with 29125 for application of the short arm splint. The consult code is appropriate because the services of Dr. OS were requested by another physician. Remember, CPT changed the instructional notes for consultations, which now state that the consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

2. Dr. OS is on call and is paged by an ED nurse to see a patient who fell down the stairs while visiting his daughter. The patient underwent a right total knee replacement two months prior by a physician in his home town and is complaining of severe right knee pain. Dr. OS requests x-rays of the patients right knee and advises the ED that he will come to see the patient in about one hour. The ED physician does not see the patient, only Dr. OS does.

In this case, Dr. OS should report the appropriate-level code from the emergency department services section (99281-99285). The outpatient consultation codes should not be used because Dr. OS was not requested to see the patient by another physician.

For further clarification, refer to section B3 15506 of the Medicare Carriers Manual.