Orthopedic Coding Alert

Question:

A patient who had a right elbow arthroplasty for displaced simple supracondylar fracture six months earlier at your practice reports to the orthopedist with complications. After a right elbow X-ray and a level-four office evaluation and management (E/M) service, the surgeon decides to perform total arthroplasty revision. Notes indicate that the surgeon revised the humeral component. How should I report this encounter?

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Answer: On the claim, report:

• 24370 (Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component) for the revision
• Modifier RT (Right side) appended to 24370 to indicate laterality
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) for the E/M
• Modifier 57 (Decision for surgery) appended to 99214 to show that the E/M led to the decision to revise the arthroplasty
• 73070 (Radiologic examination, elbow; 2 views) for the X-ray.