Health Information Management

Review codes to relieve aches and pains of reporting fractures and fracture care

JustCoding News: Outpatient, March 24, 2010

Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

by Dawson Ballard Jr., CCS-P, CPC, CEMC

Coding for fractures can be complicated. Sorting through the guidelines of when to code the fracture care versus when to code for just the casting and strapping is enough to give even the most seasoned coders headaches. So sit back, take a Tylenol, and let’s review the ICD-9 and CPT guidelines for fracture care.

ICD-9-CM for fractures

You’ll find the codes for traumatic fractures in code range 800–829 of the “Injury and Poisoning” section of the ICD-9-CM Manual. Note that this section excludes codes for the following fractures:

  • Malunion
  • Nonunion
  • Pathological or spontaneous
  • Stress

The codes for these types of fractures are listed in the 733 category (“Other disorders of bone and cartilage”) of the ICD-9-CM Manual.

Report fracture codes based on the type of fracture. For example, you would report different codes for open fractures (e.g., compound, infected, or with a foreign body) versus closed fractures (e.g., comminuted, depressed, or elevated).


Per the ICD-9-CM Official Guidelines for Coding and Reporting, you should report the traumatic fracture codes only when the patient is receiving active treatment for the fracture. Examples of active treatment include:

  • Surgical treatment
  • ED encounter
  • Evaluation and management by a new physician

When a physician sees a patient only during the recovery phase of the fracture treatment and the active treatment of the fracture is already complete, the guidelines direct coders to report these encounters with codes from the V54 category of the ICD-9-CM Manual for aftercare. Examples of aftercare include:

  • Removing or changing the patient’s cast
  • Adjusting medications
  • Removing any external or internal fixation devices
  • Follow-up visits the patient may have following the fracture treatment

CPT® codes for fracture care

The codes for treatment of fractures and/or dislocation are located in the “Surgery/Musculoskeletal System” section of the CPT Manual and classified to codes 21310–28675.

Unlike the ICD-9-CM fracture codes, the CPT fracture care codes are assigned solely based on the type of treatment, not the type of fracture. Consider the following examples of treatment:

  • Closed treatment
  • Open treatment
  • Manipulation
  • Skeletal fixation

It’s important that providers clearly differentiate in their documentation between the type of fracture and the type of treatment they provided to ensure accurate coding.

Casting and strapping

Fracture care codes include the application and removal of the first cast or traction device only. This means that when providers perform some sort of restorative treatment (e.g., traction, manipulation) to the fracture and then place a cast, you should report only the CPT code for the fracture care. The application of the cast is inherent to the procedure. But if the physician places the cast as a replacement procedure during or after the period of follow-up care, you may report the code for casting and strapping.

A 90-day surgical global period also applies to fracture care codes. So any follow-up fracture care by the provider who performed the initial care is not separately reportable. This, of course, does not apply to a casting/strapping that a provider performs as a replacement procedure.

The codes for the application of casts and strapping are also located in the “Surgery/Musculoskeletal System” section of the CPT Manual and classified to codes 29000–29799. Per CPT guidelines, report casting and strapping codes for the following situations:

  • When the cast application or strapping is a replacement procedure that occurs during or after the period of follow-up care
  • 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 the patient
  • If the physician provides the cast or strapping as an initial service, and the physician rendering the initial care does not perform or expect to perform any other procedure or treatment

But many coders struggle with understanding when to use the fracture care codes instead of the casting and strapping codes.

To answer this question, CPT Assistant, February 1996, advises coders to consider the following questions:

  • Will any restorative treatment be performed (surgical repair, closed or open reduction of a fracture or joint dislocation) or is it expected to be performed?
  • Will the same provider be assuming all subsequent fracture care?

If the answer is yes, do not report the codes for casting and strapping. Instead you should report the code(s) for the definitive treatment.

If the answer is no, you should report the casting and strapping code(s).

When the physician performs the casting and strapping in the office, providers may bill for the supplies by reporting CPT code 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) or the appropriate HCPCS Level II codes.

The provider may also report an evaluation and management (E/M) service when the key components are met at the time the physician performs the casting and strapping service. In this case, you should also append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code.

Coding scenarios

Example 1
A patient presents to the office complaining of pain in the left wrist after falling at home. The provider takes an x-ray and determines the patient’s wrist is fractured. The provider applies a short arm cast and orders the patient to follow up with an orthopedist.

To code properly, answer the following questions:

  • Was any restorative treatment performed or is it expected to be performed? No
  • Is the provider assuming all the subsequent fracture care? No

Because the answer to these questions is “no,” the provider should report:

  • 29075-LT (short arm cast) for the casting
  • 73100-LT (x-ray of wrist)
  • Level II HCPCS codes or code 99070 for the supplies

If the physician provides a significant, identifiable further service, you may report the appropriate E/M code and append modifier -25.

Example 2
An established patient presents to the office with a fracture to his right distal fibula after falling off his skateboard onto the concrete. After a problem-focused history and exam, the provider performs a closed treatment to the fracture without manipulation, applies a cast, and orders the patient to follow up with him in three weeks.

To code properly, answer the following questions:

  • Was any restorative treatment performed or is it expected to be performed? Yes
  • Is the provider assuming all the subsequent fracture care? Yes

Because the answer to the questions is “yes,” the provider should report:

  • 99212-57
  • 27786-RT (closed treatment to distal fibular fracture, without manipulation)
  • Casting supply codes

However, note that you cannot report the code(s) for the casting/strapping because the fracture care code(s) include the first application of the cast.

Editor’s note: Dawson Ballard Jr., CCS-P, CPC, CEMC, is the coding educator with Take Care Health Systems in Franklin, TN. E-mail him at dawson.ballard@takecarehealth.com.



Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

Most Popular