Podiatry Coding & Billing Alert

Question: What is the correct CPT^® code to use when billing for a patient seen while covering for a doctor from another office? The patient is new to my office and was seen two weeks after metatarsal osteotomy for a non-complicated post-op visit to evaluate incision healing, assess for potential infection, and evaluate pain management. Is ICD-10 Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) the correct diagnosis? Does the diagnosis code for the original condition also need to be included? I understand that if this were my own patient, such a post-op visit wound not be covered due to the 90-day global period. Since I am not the surgeon in this case, will I be reimbursed?  

Florida Reader

Answer: Use the same diagnosis as the one used for the surgery as the initial “A” diagnosis and pointer. Then as the secondary “B” diagnosis, I suggest one of the two following diagnoses: Z48.89 (Encounter for other specified surgical aftercare) or Z98.89 (Other specified post-procedural states).

You can bill it with a Q5 (Services furnished by a substitute physician under a reciprocal billing arrangement), since this was a non-complicated post-operative visit, if you met the qualifications for an E/M code.

If you did not meet the E/M requirements, then bill the visit as CPT^® 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a post-operative period for a reason[s] related to the original procedure). Use the Q5 modifier and don’t bill the visit to the insurance company at all. It will break even when the other physician covers for you and your patients.