Orthopedic Coding Alert

Question: When an osteoporosis patient comes in for a checkup, should I report a sick visit or a preventive medicine service?

Ohio Subscriber

Answer: If the orthopedist provides preventive medicine services, you should report 99381-99397. Coding a sick visit (99201-99215) depends on the specific service that you perform.
 
For example, a patient with controlled osteoporosis takes Fosamax and requires no medication change. If the patient comes in for an annual well visit, do not code a sick visit; instead, you should report a preventive medicine code. But if, for example, the patient complains of gastrointestinal distress every time she takes her medication, the orthopedist might prescribe a different drug.
 
In this case, you should bill an office visit code (99201-99215) because the visit was problem-oriented. Be sure to link the appropriate diagnosis code, based on her gastrointestinal problem, to the office visit. You should report the arthritis as a secondary diagnosis code.