Orthopedic Coding Alert

Question: An established patient with degenerative scoliosis reports to the orthopedist for an E/M visit. Notes indicate that it was a preoperative visit to prepare the patient for cervical laminoplasty surgery (the service occurred 48 hours before the surgery). Encounter notes also indicate a level three E/M service. Is this E/M part of the global period for the laminoplasty?

Minnesota Subscriber

Answer: It depends on the insurer. Some will not allow you to bill for this visit, though others will. If the carrier does cover the preoperative visit, report the following:

• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) ...) for the E/M
• 737.30 (Curvature of spine; kyphoscoliosis and scoliosis; scoliosis [and kyphoscoliosis], idiopathic) appended to 99213 to represent the patient's condition

Explanation: If the carrier pays for this pre-op visit, the 90-day global period for 63050 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments) begins on the day after the procedure. Any service the physician provides pre-procedure is not governed by global rules.

So if the orthopedist performs the laminoplasty on March 1, and the patient reports for a follow-up visit two weeks later so the orthopedist can check on his condition, the E/M would be bundled into the global package.

Exception: If the patient reports to the orthopedist during the global period for a problem unrelated to the surgery, you might be able to code the visit. For example, let's say the patient had cervical laminoplasty surgery on Feb. 11. On March 4, the patient reports to the orthopedist with complaints of neck pain and frequent headaches. Notes indicate the nonphysician practitioner (NPP) performed an expanded problem focused history and exam.

In this instance, you might be able to report 99213 (an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) with 784.0 (Symptoms involving head and neck; headache) and 723.1 (Other disorders of cervical region; cervicalgia) appended to represent the patient's symptoms. If you code for an unrelated E/M during a surgical global period, be sure the patient's problem is not related to the previous surgery.