Answer: If the orthopedist performs the ED visit and admission on the same date, you should combine all services that the physician performs and documents into one admission code (99221-99223, Initial hospital care, per day ...).
CPT considers all E/M services that a physician provides on the same date in another site of service part of the initial hospital care. So when your orthopedist performs same-day outpatient and inpatient services, you should include the ED work in the initial hospital care level.
Watch out: If the physician performs services on different service dates, you should bill each service. For example, the orthopedist treats an ED patient at 11:45 p.m. and admits the patient after midnight. Because the services occur on different dates, you should bill both the ED service and the admission. Report the ED visit with 99281-99285 (Emergency department visit for the evaluation and management of a patient ... ) and the admit as 99221-99223.
Don't bill an ED visit and admission unless the orthopedist performs both services. If the ED physician treats the patient but the orthopedist performs the hospital admission, each physician should report his respective service.