Orthopedic Coding Alert

Question: Can we report 29540 for strapping with other procedures, such as fracture care, or is it bundled into the main procedure?

Answer: If your orthopedist performs the strapping in coordination with fracture care, injury, or dislocation treatment, you're not going to be able to separately report 29540 (Strapping; ankle and/or foot).

Reason: CPT guidelines state that you can separately report 29540 "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." Unfortunately, payers have yet to form a consensus on interpretation of this guideline.

For example, your orthopedist performs a cortisone injection for plantar fasciitis (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) and then uses strapping to further alleviate pain. You may be able to collect for both procedures since a cortisone injection is not really "restoring" the plantar fascia, and because the injection and the strapping provide different therapeutic effects.

Watch out for bundling: In this case, you would list 20550 in line 1 of #24D of the claim form and then list 29540 with modifier 59 (Distinct procedural service) appended on line 2 of #24D.

Because National Correct Coding Initiative edits make 29540 a component part of 20550, modifier 59 lets your payer know that these are distinct services. You should link both procedure codes to the same diagnosis code, 728.71 (Plantar fascial fibromatosis).

If the surgeon does not perform the strapping in conjunction with a "restorative treatment," you should have a fighting shot at reimbursement, but your payer may disagree on your definition of restoration. Unless your payer has a specific written guideline that bans the dual reporting of the specific nonrestorative procedure and strapping, you may opt to move forward with an appeal.