Orthopedic Coding Alert

Answer: If the adjustment is made during the global period, then there is no charge at all, explains Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J. All care related to the halo is included in the 90-day global period for the procedure. Depending on how the original procedure was accomplished, it would be coded 20661 (application of halo, including removal; cranial) or 20664 (application of halo, including removal, 6 or more pins placed, for thin skull osteology [e.g., pediatric patients, hydrocephalus, osteogenesis imperfecta], requiring general anesthesia). Each procedure has a 90-day global period.

What happens after the global period? Adjustments to a halo, without anesthesia, are part of the evaluation and management [E/M] service rendered, explains Brink. And the E/M service falls into categories such as office or outpatient.

Brink says an adjustment to a halo should be documented in addition to other components of the E/M service (e.g., history, exam, decision-making). And she adds, The code charged for office visit E/M service, 99212 through 99215 for established patient depends on the level of service. The documentation in the patient record must back up the level of service.

Coding Tip: In order to use an E/M code during the global, there must be a separately identifiable E/M service using an appropriate modifier such as -24 (unrelated evaluation and management service by the same physician during a postoperative period).