ED Coding and Reimbursement Alert

Question: A patient with gamekeeper's thumb reports to the ED. The operative notes indicate the physician examined the thumb and index finger, made the diagnosis and immobilized the thumb. Can I report a separate E/M service in this scenario, and what CPT code should I report for the immobilization?

Idaho Subscriber Answer: Make sure your physician's documentation indicates a separately identifiable E/M service that goes beyond what is incidental to the procedure. In the scenario you describe, the physician might perform history and physical exam elements that go beyond simply immobilizing the thumb, in which case you would report a low-level E/M code.

The answer to your second question depends on the immobilization technique the ED physician uses. When she performs the immobilization using an ACE bandage or other strapping material, report 29280 (Strapping; hand or finger) for the service.

If she applies a thumb spica cast to immobilize the injury, report 29075 (Application, cast; elbow to finger [short arm]) for the service. No matter which CPT code you choose, include 842.12 (Sprains and strains of wrist and hand; metacarpophalangeal [joint]) on the claim to represent the patient's thumb condition.