Orthopedic Coding Alert

Question: Encounter notes indicate that after the orthopedist performed a level-four office evaluation and management (E/M) service for an established patient, the orthopedist performs closed treatment of two right hip socket fractures. There is no mention of manipulation or skeletal traction. Can I report a CPT^® code for each socket fracture repair?

Louisiana Subscriber

Answer: No, you cannot report two surgical codes for this encounter. on the claim, report:

• 27220 (Closed treatment of acetabulum (hip socket) fracture(s); without manipulation) for the fracture repairs
• Modifier RT (Right side) appended to 27220 to indicate laterality, unless the payer doesn’t requires it
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) for the E/M
• Modifier 57 (Decision for surgery) appended to 99214 to show that the socket repairs and the E/M were separate, significant services.

Explanation: In the descriptor for 27220, it specified hip socket “fracture(s)”; this means that you should only report 27220 regardless of the number of fractures the orthopedist repairs.