Orthopedic Coding Alert

Question: Our orthopedic surgeon completed a consultation in the Emergency Room with a patient who had a segmental tibia fracture. He performed surgery the next day and saw the patient three times during rounds that day. Can I report the room visits and add a modifier, or are they not billable?

Arizona Subscriber

Answer: Aside from the surgical procedure, only the consultation in the ER is billable. Report the appropriate choice from 99251-99255 (Inpatient consultation for a new or established patient ...).

Although your surgeon saw the patient several times after her procedure, you can't report a subsequent hospital care code (99231-99235, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Your physician's visits are considered part of the standard postoperative care.