Orthopedic Coding Alert

Question: Can we bill for a brace fitting prior to surgery? If so, what codes do we report?

New York Subscriber

Answer: Verify the purpose of the fitting before attempting to code. If the measurements were simply taken for the orthopedist, the work is included in the E/M service 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

If it was for another reason, you can submit 97760 (Orthotic[s] management and training [including assessment and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes). Note that this is a time-based code, which means your provider must document the amount of time spent rendering the service before you can submit the code.

Other key items to document could include exercises to be performed in the orthotic, instruction in skin care and orthotic wearing time, and time associated with modification of the orthotic due to healing of tissues, change in edema, or interruption in skin integrity.

Supply check: If you're providing the brace, you can also report the supply code. HCPCS includes many options, so let the case specifics guide your choice.