Orthopedic Coding Alert
Consultations
Question: I've been submitting 99241-99245 when one of my surgeons does a consultation in the emergency department (ED), but I'm getting denials for place of service. How should I code these consultations? Hawaii Subscriber Answer: CPT states that 99241-99245 (Office consultation for a new or established patient ) are for "office or other outpatient consultation," so they are not limited to office visits. The description at the beginning of the section reads, "including hospital observation, home, domiciliary, rest home, custodial care, or emergency department." Perhaps the carrier denying the claims has an internal policy that limits the place of service that can be reported with these codes, which would be an incorrect interpretation of CPT guidelines. You should contact the payer's provider relations department to resolve this issue. Answers to You Be the Coder and Reader Questions were provided by Heidi Stout, CPC, CCS-P, coding and reimbursement manager for University Orthopaedic Associates in New Brunswick, N.J.
Orthopedic Coding Alert
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Status Code Issue
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Use -32 for Mandated Services
Modifier -32 (Mandated services) describes procedures or services required by a third-party payer, governmental or [...] - Reader Question:
Previous Hip Procedure
Question: The patient had an acetabuloplasty with resection of the femoral head. While still in [...] - Reader Question:
Open Reduction
Question: Our surgeon spent 10-15 minutes on a patient, attempting a closed reduction with percutaneous [...] - Reader Question:
Pain Catheter
Question: How should we code for the insertion of a pain catheter? Because the catheters [...] - Reader Question:
Perilunate Dislocation
Question: The physician performed an open reduction and pinning of a perilunate dislocation. What is [...] - Reader Question:
Consultations
Question: I've been submitting 99241-99245 when one of my surgeons does a consultation in the [...] - Correction:
The May 2002 "Modifier of the Month" column regarding modifier -77 should have stated that [...]
