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Thread: Orthopedic consultation

  1. #1
    Join Date
    Apr 2007
    Anaheim, CA

    Smile Orthopedic consultation

    AAPC: Back to School
    If a patient is send to a specialist for a consultation, and the specialist treat the fracture.

    Can the specialist code for a consult code and the Fx treatment code or the fracture treatment is included in the E/M code ( so not seperately codable) or any other way.

    Please respond, I would really appreciate any help.


  2. #2

    Default specialist consult and tx of fx

    Hi, Alka. I looked in the Consultations section of the CPT 2007 (I don't have a 2008 edition) and it says that any specifically identifiable procedure (i.e., identified with a specific CPT code) performed on or after the date of the initial consultation should be reported by the consulting specialist.
    So any services such as radiologic dx/manipulation/reduction/fixation should be reported on separate line(s) of your claim, or else those services will not be reimbursed by the insurance carrier.

    Anyone out there who may be reading this, please correct me if I am wrong.
    Ruth (student coder)

  3. #3

    Default consult question

    hi Alka,

    if you used a fracture treatment code(with global days example: 27193-27269) then only the procedure code will be reported.
    subsequent visit with in the global period is not billable either.(99024)

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado


    If the patient is sent to the specialist for definative treatment, then only the fracture care code should be reported.

  5. #5
    Join Date
    Apr 2007


    The initial visit with the specialist may be billed with an E/M code (with the -57 modifier--decision for surgery) in addition to the fracture treatment. If casting is necessary, this is NOT coded as it included in the fracture care for that first visit. All subsequent visits are considered post op for the global period, however the casting and x-rays are codable for those follow up visits.

  6. #6
    Join Date
    Apr 2007
    Kansas City MO


    I completely agree w/MBort with the following exceptions. If there is any type of complication, i.e., infection, you can append a modifier 24 to the e/m follow-up care and link with an appropriate dx code. Also, if the ortho consultant performed closed treatment for a fracture simply to stabilize it until a more definitive ORIF can be performed, you should only bill for the consult with the 57 modifier.

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