Orthopedic Coding Alert

Question: Our orthopedic surgeon recently took over the postoperative care of another surgeon's spinal-fusion patient. Should we report E/M codes for these visits, or the surgical code with modifier -52 appended?

New York Subscriber

Answer: If you assume a patient's postoperative care, you should report the code for the surgical procedure and append modifier -55 (Postoperative management only).
 
The Physician Fee Schedule divides the percentage of relative value units into a procedure's pre-, intra- and postoperative components. Appending modifier -52 (Reduced services) to the surgical procedure tells the carrier that you performed a reduced service (and it doesn't sound as if your surgeon did), so this modifier isn't appropriate in your scenario.
 
You should report an E/M code (99201-99215 for outpatients, 99221-99233 for inpatients) only if the orthopedist treats another problem that's unrelated to the original surgery. In this case, you would append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code.
 
Note: See our article "One Modifier Collects Reimbursement for Skiing Injuries - If You Know the Rules" on page 9 of this issue for more information about modifier -55 and its counterpart, modifier -54 (Surgical care only).

 - You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J.