Orthopedic Coding Alert

Question: I had no trouble coding for an ostectomy for a calcaneus spur, but I’m not sure how to code the resulting cast. Because the spur was on the heel, the cast only goes halfway up the leg, used for ambulatory purposes. How do I code this type of cast?

New York Subscriber

Answer: For a cast of that size, code 29425 (Application of short leg cast [below knee to toes] walking or ambulatory type).

You should be wary of global period requirements. Your orthopedist may decide that, due to medical concerns like pressure from an ulcer, that the cast needs to be changed. In this situation, keep your 29425 code and add the modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to accurately report the entire casting procedure.

Tip: Other codes can be bundled with cast applications. If you do need to add modifier 58, you can also make good use of code L89.5- (Pressure ulcer of ankle…), using the fifth character to specify laterality and the sixth character to indicate the degree of healing. To report these extra codes be sure the orthopedist fully documents these issues.

With many applications of casts, further devices might be used to help the patient recover. You need to be ready to code these extra devices like 29440 (Adding walker to previously applied cast) if your surgeon later adds on a walker to mobilize the patient.