Orthopedic Coding Alert

Question: Encounter notes indicate that after a level-four evaluation and management (E/M) service for a new patient with Felty’s syndrome in the left wrist, the surgeon performed wrist arthroplasty with interposition but no mention of fixation. How should I code this encounter, and what exactly is Felty’s syndrome?

Arkansas Subscriber

Answer: For this claim, you’ll report:

• 25332 (Arthroplasty, wrist, with or without interposition, with or without external or internal fixation) for the arthroplasty
• Modifier LT (Left side) appended to 25332 to indicate laterality
• 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.) for the E/M service
• Modifier 57 (Decision for surgery) appended to 99204 to indicate that the E/M led to the surgical decision
• M05.032 (Felty’s syndrome, left wrist) appended to 25332 and 99204 to represent the patient’s condition

Felty’s syndrome explained: According to Codify by AAPC, “Felty’s syndrome consists of three concurrent conditions: rheumatoid arthritis, or RA, splenomegaly, a swollen spleen, and leukopenia, a decreased white blood cell count. The rheumatoid arthritis affects the carpal joints of the left wrist.

“In Felty’s syndrome, symptoms include malaise, fatigue, loss of appetite, weight loss, swelling, stiffness, and pain in the joints, recurrent infections, and eye burning and discharge.”