Orthopedic Coding Alert

Question: I was called to see a 90-year-old man who had fallen and fractured his right hip. He was admitted by his family doctor to a hospital 30 miles from my practice. I did a consult and did surgery to repair the hip. Can I use the consult code with modifier -57 and the surgery code? This is not a transfer of care. The patient has heart and other medical problems and is still under the care of his family doctor.

Ted Honghiran,
MD Orthopedic Surgeon

Answer: Yes. "The orthopedists in this case would bill the consult and append the modifier -57 (decision for surgery) to the consult code," says Sheri Benton, CPC, a coding and reimbursement specialist at the Cleveland Clinic Foundation, department of orthopedics. "The surgery code would depend on the type of hip fracture."

The key here is that this is not a transfer. (For more information on consults see article on Medicare Clarification of Consultations on page 75 of this issue. Also see the article Coding Correctly for Transfer of Care vs. Consults Can Stave Off Auditors in the March 1999 issue of Orthopedic Coding Alert on page 17.)

A report must be prepared for the referring physician in order to document that this is a consultation. And in the postoperative period, the family physician must resume all responsibility for care.

When billing for the consultation, be sure to include the name and Unique Physician Identification Number (UPIN) of the requesting physician.