“How do you code for a hospital consultation when the patient is in the postoperative global period from another surgeon? I was called to the local hospital to see a patient that was transferred for medical treatment for an unrelated condition. He had a transmetatarsal amputation (TMA) performed for apparent osteomyelitis at the other hospital by a different podiatric surgeon. I was consulted to evaluate the TMA site and make recommendations for management. How do I code the diagnosis and E/M for this post-operative consultation?”
It should not make a bit of difference when a physician is requested to perform an in-patient hospital consultation on a patient that is in a postoperative global period based upon a procedure that was performed by another surgeon. In the above post, the patient was admitted to a local hospital for an unrelated condition. The podiatrist is consulting regarding a TMA that was previously performed for what appears to be osteomyelitis. An initial hospital inpatient evaluation and management code can be billed by the consulting physician as long as the patient has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice during the patient’s hospital stay.
A medically appropriate history and a medically appropriate examination of course needs to be performed by the consulting physician. Based upon the physician’s evaluation and findings at the surgical site, specifically the previously performed TMA, recommendations and a treatment plan need to be initiated. Based upon what specifically is the treatment plan and access to the “Elements of Medical Decision-Making Table,” the level of E/M service can be established. The E/M code selected will either be CPT 99221 or CPT 99222.
• CPT 99221 is defined as the following: Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making.
• CPT 99222 is defined as the following: Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
What about the ICD-10-CM codes:
Z89.431/Z89.432: Acquired absence of right foot/Acquired absence of left foot
M86.271 /M86.272 Subacute osteomyelitis, left ankle and foot/ Subacute osteomyelitis, right ankle and foot, or a more specific ICD-10-CM code for osteomyelitis based upon the history and examination.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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