Results 1 to 6 of 6

Orthopedic consultation

  1. #1
    Anaheim, CA
    Smile Orthopedic consultation
    Medical Coding Books
    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. 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. 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
    Greeley, Colorado
    If the patient is sent to the specialist for definative treatment, then only the fracture care code should be reported.

  5. #5
    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
    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.

Similar Threads

  1. Orthopedic billing
    By monique11367 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 12-15-2014, 12:01 PM
  2. orthopedic question
    By OEHMLER5 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-16-2014, 12:53 PM
  3. Wiki Orthopedic Aftercare - When coding a follow-up
    By NFBarner in forum Orthopaedics
    Replies: 11
    Last Post: 06-11-2011, 06:07 AM
  4. Orthopedic E/M
    By nyyankees in forum E/M
    Replies: 1
    Last Post: 10-18-2010, 02:41 PM
  5. Orthopedic Coding Help
    By KIMBO101080 in forum Orthopaedics
    Replies: 1
    Last Post: 09-30-2009, 09:38 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.