Orthopedic Coding Alert

Question: Our orthopedist often asks patients to return to our office 90 days after a fracture so we can ensure that the injury is healing properly. If the patient has no pain or other symptoms, can we still bill an E/M code, and if so, which diagnosis code should we use? We also see total knee and hip replacements one year after surgery for rechecks, and we have a similar problem deciding on diagnoses for these visits.

Pennsylvania Subscriber

Answer: If your orthopedist performs a fracture follow-up visit outside of the global period, you can report the appropriate-level E/M code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). You should bill a diagnosis code from the V54.10-V54.19 series (Aftercare for healing traumatic fracture).

If the physician sees the patient after the fracture has already healed, report V67.4 (Follow-up examination; following treatment of healed fracture) instead.

If your patient returns for a routine follow-up after the orthopedic surgeon performs total joint replacement surgery, report V67.09 (Follow-up examination; following other surgery) along with the V code that reflects the joint replacement status (such as V43.64, Organ or tissue replaced by other means; joint; hip; or V43.65, ... knee).