Orthopedic Coding Alert

Question: A local orthopedic surgeon (not in our practice) recommended an arthroscopic SLAP repair (29807, Arthroscopy, shoulder, surgical; repair of SLAP lesion) for his patient. But before the patient's insurer would approve the surgery, the payer asked our surgeon to conduct a physical examination of the patient. We-d like to report 99243 for this service, but that's what the first surgeon reported. Will the insurer reject our claim as double-billing?


New Mexico Subscriber

Answer: The insurer might reject your claim for the consult, unless you append modifier 32 (Mandated services) to 99243 (Office consultation for a new or established patient ...).

Modifier 32 signals the carrier that the payer requested the consult and that the service is therefore not a redundant claim. The modifier generally describes procedures or services required by a third-party payer, or a governmental or legislative agency.
 
You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P; and Bill Mallon, MD.