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subspecialties and on-call services

Krisan Posted Tue 03rd of March, 2015 16:11:18 PM

We have several subspecialties within the same orthopedic practice: ortho trauma, ortho spine, ortho foot/ankle, ortho general. They all share on-call duties, and then refer to the appropriate subspecialist. So, when one orthopedist is on-call, sees an emergent patient and reduces and splints a fx and documents everything appropriately, including the plan for the ortho trauma doc to operate the following day; does the on-call orthopedist bill anything, or would her service be considered global to the ORIF on the following day? (I know about fx care vs itemizing. I’m just not sure how all this fits together when all physicians are in the same practice but different subspecialties.)
As always, where are the coding guidelines for this situation?
Thank you.

SuperCoder Answered Wed 04th of March, 2015 09:18:35 AM

Hi Krisan,
Thank you for the query.
If orthopedist applies cast as an initial service (e.g., casting of a sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code in addition to an evaluation and management code as appropriate.

Hope it helps you.

Thank you

Krisan Posted Fri 06th of March, 2015 11:23:07 AM

As stated in the initial question, the on-call orthopedist REDUCED and splinted the fx and planned for the trauma orthopedist to operate the following day. Should the on-call orthopedist bill 24505-54 and the trauma orthopedist bill 24515-58? Is that allowed when both MDs are in the same practice? I need documented guidelines to support my coding.

SuperCoder Answered Mon 09th of March, 2015 10:38:26 AM

Hi Krisan,
Thank you for the query.
I don’t think that it is allowed. As ORIF is the restorative treatment planned earlier, it is the trauma orthopaedist who will bill for it with CPT code 24515 and the emergency department orthopaedist will only bill for strapping/cast codes from the series 29000-29799.

Hope it helps you.
Thank you

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