Wiki E/M Orthopedics

[cynsteve04@aol.com]

Does anyone know of a good Orthopedic Webinar for E/M specifically for Ortho. The Drs want example of chronic illnesses with exacerbation and or severe. They believe if the patient requires its automatically 99214.
Karen Zupko webinars are just an outline of the change and doesn't go deep into examples of what would be considered a 99214

 

[amyjph]

It's not going to be a 99214 coded by MDM if one of the other columns doesn't meet moderate, usually if your COPA is moderate it will probably meet one other level because of the data, not always though. Is your practice general ortho or all subspecialties?
Seems they should be the ones stating examples of 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment Always go back to the definitions in the CPT E/M section. Read the definitions after each bold COPA section. Chronic severe could be when they admit from the office. I have seen where someone comes in because they have had "leg pain" or trouble walking, the provider sees them and they actually have a fracture that requires admission that day for surgery (example). A helpful way is to take some of their own notes at varying levels of E/M, review or audit them, and then get together with the provider to discuss. Once a surgeon told me to think of it this way, "How bad is it, what are we doing about it, and how soon did we tell them to come back and follow up?" That helped me have an idea of severity. Granted, you can't code with it, but it helped me look at it differently.

This is from ACEP, not ortho specific, but does have helpful examples of COPA. See #9-15: https://www.acep.org/administration/reimbursement/reimbursement-faqs/2023-ed-em-guidelines-faqs

AAOS had some webinars for E/M done by docs. These are specifically for the 2023 changes but they do have Q&A, talk about COPA, and helpful info. They also had some for the 2021 changes too. In this video around 15 minutes, they specifically discuss COPA: https://www.aaos.org/videos/video-detail-page/26619__Videos

https://www.aapc.com/blog/51038-gain-solid-footing-for-orthopedic-e-m-coding/

Chronic with exacerbation could be LBP, they came in 4 weeks ago, tried PT & meds prior, they are back for f/u and getting worse, pain worse, meds and PT not helping. Now, they move on to ordering an MRI, changing meds, and possibly talking about surgery or injections. Severe might be this same scenario and you do the MRI same day in house, they have a disc herniation that is now so bad they have neuro/leg symptoms, uncontrolled 10/10 pain and you take them to the OR later that day. Physiatry, spine, total joints and ortho-oncology are what come to mind for chronic COPA. Sports/trauma will be more the acute COPA. Hand/wrist, foot & ankle, hip scopes - those could be all over the place.

The Auditor's Desk Reference from Optum has some examples, again, not always ortho specific, but an idea.