Podiatry Coding & Billing Alert

Question: A patient had an orthopedic surgeon put a pin in her second toe on her left foot to correct a deformity. The patient decided she wanted a second opinion from a podiatrist during her post-op, so she came to our office as a new patient. Should I report an E/M code or should I report a post-op visit using the procedure code and a modifier?

Nevada Subscriber

Answer: You should report an E/M code. Specifically, you should report the appropriate new patient office visit codes (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...) based on the level of service your podiatrist performed. Assuming your podiatrist is not part of the same practice (reporting under the same tax identification number) as the orthopedic surgeon, you can report the E/M service without any modifiers or additional coding. Because your podiatrist was not involved in the surgical planning and is providing only a second opinion, not post-op care, you should not report the procedure code with a modifier.