Orthopedic Coding Alert

Question: I am confused about billing for the orthopedic surgeon’s evaluation of a hospitalized patient (admitted by another physician) with a known orthopedic injury. An example is a patient is admitted by the primary-care physician with a hip fracture. The orthopedic surgeon is "consulted" regarding the fracture. The surgeon typically performs a comprehensive evaluation of the patient before surgery. The initial hospital care codes (99221-99223) are for use by the admitting physician. The CPT manual states "for initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate." It appears that a consultation code (99251-99255) is not appropriate because the surgeon has been asked to perform a specific treatment. How does one bill for the surgeon’s evaluation of the patient?

Ronald Connar, MD

Answer: The orthopedist should use the subsequent hospital care codes (99231-99233). These codes are to be used to indicate services "subsequent" to the initial hospital codes by any physician rendering care to the patient.