Orthopedic Coding Alert

Question: I treated a patient for the following:

1. Fracture care of left hand original injury six weeks earlier (26600).

2. Injury to right hand from a car accident, which the patient wants to bill to auto insurance. X-rays for right hand were taken.

3. Patient also has left hip osteoarthritis and was evaluated for this problem during this office visit. Patient wants to charge Medicare for this evaluation. X-rays of pelvis and left hip were taken.

Who is charged which portion of this bill? In particular, who is charged for the evaluation and management (E/M) office visit?

Arkansas Subscriber

Answer: Unless there are separate and distinct notes for all of these problems, it is difficult to say which carrier would be billed for the E/M service. Do not bill Medicare for the E/M service unless a lot of the visit time was spent on the hip problem. To determine who gets billed for the office visit, ask the following: What was the majority of the visit spent on? What was the most pressing problem during the visit? Those are the most likely deciding factors.

For the x-rays, bill the carrier who deals with that specific problem related to the x-ray, either the auto insurance or Medicare.