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Additional ER consult between 2 Hip Surgeries

  1. Unhappy Additional ER consult between 2 Hip Surgeries
    Medical Coding Books
    Day 1 = Dr A saw pt for initial hsp consult, and it was determined pt required percutaneous pinning of the R hip.
    Day 3 = Dr B performed percutaneous pinning of the R hip Fx
    Day 5 = Dr B discharged pt to nursing facility for rehab

    **Pt then returned to ER 16 days post surgery (seen by Dr B) with her leg externally rotated, X-rays revealed displaced Fx.**

    (The following day, pt had Hemi (post Fx) performed by Dr C.)

    I should note all surgeons are from the same practice.
    ?? How is the return to the ER (on the 16th post op day) billed prior to the final surgery?
    Just post op 99024? Or can we bill another consult? hmmmm...

    I am thinking 99024, just would like to be sure. Thanks.

  2. #2
    Leesburg, VA
    You're absolutely right- it's needs to be 99024- especially since surgeons A and B are from the same practice.

    The only way you'd be able to post that additional ER consult would be if the patient was coming back to the ER for something completely unrelated to the original surgery.

    Have a great day!
    Catherine J. Steburg, CPC, CEMC
    Leesburg, VA Chapter President

  3. Default
    Ahhh... I can go home this weekend without worrying about 'That one last question'!! Thanks again!!

  4. #4
    Louisville, KY
    I think you might be able to get an E/M with -24 mod in this instance. I'm not saying for certain, because I can't review your record...

    Case in point, this "displaced" fracture . . . I'm pretty sure this is going to code to a complication in ICD. Although most minor post-op complications are included in the global package, if there's more to the story (so to speak) with this displaced, subsequent fracture, I think you're justified in adding a -24. This subsequent fracture we're assuming is related to the previous surgery. That may not pan out to be true from the clinical standpoint. I'd at least consider reviewing the record and op report to determine if we had a mechanical failure of the previous pinning, a subsequent fall or overexertion or an underlying clinical picture that resulted in a return for fracture re-reduction.

    I am simply suggesting to look more closely at the information (include it here if you want); I find that situations like this sometimes have features that are out of the ordinary and require some added research and perhaps coding that's "outside the box."

    Hope this helps and I look forward to hearing more about this situation.

  5. #5
    Thumbs up
    Good answer/reply Kevin....


  6. #6
    Leesburg, VA
    Thumbs up
    Ooh! Kevin's absolutely right! I didn't read close enough to see that it was a "re-fracture".

    Good on ya, Kevin, thank you for catching that!
    Catherine J. Steburg, CPC, CEMC
    Leesburg, VA Chapter President

  7. Lightbulb
    Hi all!!
    I was not sure what caused the displaced fx as it was not noted in the patients records so I did refer back to Surgeon 'B' today.
    Surgeon B stated there was no fall prior to the return to the ER, however he believes the pt was non-compliant and weight bearing though she was supposed to be NWB.
    I would think this is classified as overexertion... So do you think this is a billable consult with the mod -24? Or are we to consider this part of the global period of the original surgery?
    I hope this is enough info for your opinions...
    Thanks so much!

  8. #8
    Louisville, KY
    Well, in OP and Pro fee we only code a Dx to its degree of certainty, so I'm not sure if that's opening another can of worms here...

  9. Default
    Thanks everyone!!

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