Orthopedic Coding Alert

Question: Our orthopedist treated a pregnant patient for an open femoral fracture (820.10). He met with two other members of her medical team (an obstetrician and a rehab physician) for 35 minutes. Is there a way to bill for this time?

California Subscriber

Answer: The answer depends on the patient's insurer. Although Medicare and Medicaid won't pay for any physician encounters that don't involve face-to-face time with the patient, you may be able to collect reimbursement from private payers by coding for team conferences.
 
If a private payer insures the patient, determine whether the insurer accepts 99361 (Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care [patient not present]; approximately 30 minutes). Before reporting this code, ensure that your documentation appropriately describes the meeting participants, the treatment plan, and the proof of the time spent discussing the patient.