Orthopedic Coding Alert

Question: After examining a patient in our emergency room, the orthopedist decided the patient would be admitted and later taken to surgery for ORIF (open reduction internal fixation of proximal femur fracture). A history and physical are documented, and surgery is performed two days later. Should we code for initial hospital care, an ER visit or what?

Billing Supervisor, Detroit, MI

Answer: Because the patient was admitted, you will not use the emergency department codes, but instead you should use the E&M code 99221 (initial hospital care). You can add modifier -57 to code 99221 because this identifies an E&M service that resulted in the initial decision to perform surgery . . . used in cases in which the decision for surgery was made during the preoperative period of a non-starred surgical procedure . . . used with E/M visits furnished during the global period of minor procedures (0 to 10 day global) .