ED Coding and Reimbursement Alert

Question: We often see patients with sprains or fractures and the ED physician uses casting/strapping as a temporary stabilizer until the patient can see a specialist. Are these included in the E/M code or can we use the casting/strapping codes (29000-29799) in these situations?

Colorado Subscriber

Answer: Before you report an application of casts and strapping code from the 29000-29799 range, you must first understand how the CPT^® guidelines instruct you to submit these codes. You can only report these codes under the following conditions:

“When the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient,” or “When the cast application or strapping is a replacement procedure used during or after the period of follow-up care.”

Note: Although casting and strapping cannot be separately billed on the same date that an associated treatment (like a fracture reduction) is billed, it can be billed when the patient returns for follow up if the cast has to be replaced for any reason, like damage to the cast or need for a different size of dimension.

The application of casts and strapping codes 29000-29799 can be used to report services when the physician is not providing definitive care because surgery might be required or the care is out of their scope. The physician may provide an evaluation and management (E/M) service and stabilize the injury, which is often the case in the ED. However, if the ED physician is providing definitive care, then typically the non-manipulated fracture care code would be used and the splinting service would be bundled. If reporting the non-manipulated fracture care, keep in mind that the 54 modifier (Surgical care only) would be added if the emergency physician is not performing the follow up visits.

If the cast or splint is applied because the ED physician confirms the fracture but refers the patient to a specialist for fracture care, then you should bill the appropriate casting/ splinting code (29000-29799) along with the appropriate E/M code. You should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code.

Codes 29000-29799 represent the work to create the immobilization device. Look for documentation of materials used such as stockinette, Webril, plaster, or fiberglass.

Bottom line: The only time you can use a code from the 29000-29799 range is when your provider applies an initial cast or strapping or replaces one that has already been applied. No restorative treatment or procedure or any other kind of follow-up care may be involved, either before cast or strapping application or after.