ED Coding and Reimbursement Alert

Question: A patient presented with an injured arm, which the physician discovered was broken after examining the patient and reviewing an x-ray. The physician then applied a long-arm cast to the patient. Am I allowed to report a separate E/M service along with the cast application?

New Hampshire Subscriber
 
Answer: In this case, absolutely. Report the cast application 29065 (Application of cast; shoulder to hand [long arm]). For the E/M service, report a code from the 99281-99285 series (Emergency department visit for the evaluation and management of a patient, which requires three key components ...).
 
The doctor could not have known the arm needed casting without performing a history, physical exam and an x-ray, so those factors make the visit a legitimately separate E/M service.