Orthopedic Coding Alert

Question: Encounter notes indicate that the provider performed an office evaluation and management (E/M) service for a new patient that included low-level medical decision making (MDM) and lasted 27 minutes. Then the provider performed X-rays on the patient’s left knee. How should I report this encounter?

Georgia Subscriber

Answer: Your answer will depend on how many views that the provider took during the X-rays. On the claim, choose from the following codes depending on the view count:

• 73560 (Radiologic examination, knee; 1 or 2 views)
• 73562 (… 3 views)
• 73564 (… 4 or more views).

Be sure to append modifier LT (Left side) to the X-ray code to indicate laterality.

Then, report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.) for the E/M service. Since you can report office/outpatient E/ Ms based on time or MDM, using MDM will get you to 99203. If you coded based on time, you’d have to report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/ or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) — which is technically correct but will cost your practice money.