Auditing Orthopedics


Yakima, Washington
Best answers

I am looking for someone to help me with questions regarding auditing office visits. We had a provider in our office that sent out 50 office visits. When I got the audits back I became very confused as to how she came up with the level of MDM. I am hoping someone will help me with questions and keep an ongoing relationship so we can help eachother. If anyone has any suggestions, questions, or willing to help please email me.

Amanda Ballard

Thank you in advance :)


True Blue
Salt Lake City, UT
Best answers
E/M coding for ortho is inherently problematic. The reason for this is that the exam portion is usually very limited which will bring the code down. MDM is the same way. To be honest, I think that MDM really should be the key factor in choosing an E/M in orthro since the ROS and EXAM are inherently very limited. However, when the patient returns for a follow up on a fracture it would be easy to give the physician one point in MDM for one stable condition and give the provider a 99212. If you are very strict, all of your follow up visits would be 99212. But I think that is cheating the physician. I reviewed an E/M for ortho by the AAPC and the presenter suggested that 99213 should be used for a condition being treated. Using the key components, you may not get a 99213. If a fracture is still healing, I really think the physician deserves the 99213 instead of 99212. I'm amazed as my docs read the X-rays and they can tell that the bone is healing, or not as compared to the previous X-rays. I think they deserve credit that the key components may not really give them. Generally for a new patient the E/M should be 99203. The only time it should be 99204 is if the doc is dealing with multiple issues. Follow up visits should generally be 99213 (I believe) and 99212 should be reserved for when the patient is healed and no longer needs to be followed. It would be interesting to see a few of the notes and see what level was suggested.