Wiki Application of casts and strapping


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We have a situation that has created quite a debate in our office that we could use some advice on.

Here's the scenario: a patient presents to the clinic with a fracture. The physician evaluates the patient and stabilizes the fracture with casting or splinting prior to surgery at a local hospital later in the day. So, our question is this: can the casting or splinting at the evaluation visit, prior to the surgery be billed? It would be billed like this: 99204-25/57, 29075-LT, and Q4010. Then the surgical procedure would be billed later in the day. The CPT book seems contradictory when it comes to this and we can't come to an agreement in our office.

PS - The same physician is doing the evaluation in the morning and the surgery later in the day.

Any help would be GREATLY appreciated!!

Thank you!
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That is also what the book states however, I feel like there's a piece that isn't addressed. The CPT book states "An individual who applies the initial cast, strap, or splint and also assumes all of the subsequent fracture, dislocation, or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes". But, what if we're billing an E/M with the casting - the casting isn't included in an E/M service.

Also, the book goes onto state "A temporary cast/splint/strap is not considered to be part of the preoperative care...". This statement seems to contradict the last one...? And, if this isn't a temporary cast situation, what is?

My thought process is that the physician has to stabilize that fracture before he/she does surgery later that day. It's medically necessary so, do they just have to eat those casting/splinting codes?

These are the arguments we are coming across. It's so grey in the book and we aren't able to find any definitive information about it.

Thank you!
My understanding is that if you are planning any restorative care like the surgical procedure later in the day, you would bill the fracture code and then append modifier 58 on the surgical code.