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Code casts and straps properly

HIM Connection, February 8, 2005

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If an ED patient is fitted only with a cast/strap or splint and is not subject to restorative treatment, use casting and strapping codes to reflect these services. The range of CPT codes include 29000-29750. Review the following for examples of when to use and when to avoid casting and strapping codes:

Example 1: A patient presents with a closed proximal fibular fracture. The ED physician places a cast on the lower leg and refers the patient to his or her primary care physician (PCP) for follow-up. Code the fracture care with HCPCS 27760 (closed treatment of medial malleolus fracture, without manipulation) because the ED physician provided the restorative fracture treatment. The PCP will not provide restorative treatment. Do not add casting or strapping codes because the procedure includes the cast application. Report cast supplies under revenue code 272.

Example 2: A patient presents to the ED with a wrist fracture. The ED physician places a short-arm splint on the wrist but realizes surgery is necessary and refers the patient to the orthopedic surgeon. The ED does not code the restorative fracture treatment because the case is referred to a specialist. Code HCPCS 29125 (application of short arm splint, static) for the application of the splint. Code the appropriate HCPCS level two L code for the splint under revenue code 274. "There's been a lot discussion over whether the level two codes are reimbursed by your fiscal intermediary [FI]," says Pam Hess, RHIA, CPC, ACS-OP, director of Navigant Consulting Inc., in Nashville, TN. "We've seen cases where they are and where they are not." Follow up with your FI to determine whether it will pay for the level two codes. "If it's not, ask why not, because it is supposed to be paying the facility for those codes," Hess says.

Proper documentation
To properly code the supply items used during casting and strapping procedures, you must document specific information about the supply. Use the following checklist to ensure that you thoroughly document the information:

• Purchase or pick-up location of the supply (e.g., physician office, local medical supply company, outpatient department).
• Manufacturer.
• Model or item number.
• Name of item (e.g., wrist splint, full-body cast, long-leg cast, knee immobilizer).
• Anatomical site placement of supply. In the case of a cast, specify cast.

This excerpt is adapted from a Briefings on APCs special report.

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