Orthopedic Coding Alert

Question: What codes should I report for a patient who received strapping for skier's thumb?
Montana Subscriber Answer: The appropriate diagnosis code for skier's thumb is 842.12 (Sprains and strains of wrist and hand; hand; metacarpophalangeal [joint]). This injury involves damage to the ulnar collateral ligament, often from the ski pole strap or grip damaging the thumb during a fall. Term tip: You may see this injury documented as an ulnar collateral ligament tear or rupture, or as -gamekeeper's thumb- (typically the result of chronic injury rather than acute). CPT: If the surgeon applies only strapping, you should report 29280 (Strapping; hand or finger). If he instead applies a thumb spica cast, you should report 29075 (Application, cast; elbow to finger [short arm]). You also may report an E/M code if your surgeon's documentation indicates a separately identifiable E/M service that goes beyond what is incidental to the procedure. In the scenario you describe, the surgeon 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.