# Pain From Cast



## jvargocpc (Oct 24, 2008)

I have a question on an ER that I'm trying to code. The patient had a cast placed on her arm at another hospital, but came to our ER with arm pain at the location of the cast and finger swelling. On examination, the ER physician noted mild edema of the fingers and no significant pain with flexion/extension.

The cast was removed and a new one applied. Patient had relief of pain.

I am charging for the cast removal and new cast application, but do I use a modifier on either of them?

I can't find a code under, complications, pain, fracture, etc, that states the pain was due to an external fixation device with no internal components. Can you give me any thoughts on what ICD-9 codes to use?


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## FTessaBartels (Oct 24, 2008)

*Signs/Symptoms and V code*

This is NOT my area of expertise, but I'm thinking ..

I'd code the edema, arm pain and the V code.
Look at V54 section in ICD-9 to see if one of those Orthopaedic Aftercare codes fits. 

I asked our ortho coder what she would use if the patient came to clinic with this scenario and she'd use the Aftercare codes. In the absence of specific information about the original fracture, V54.89 ... if you know whether fracture was traumatic vs pathological and the specific site (upper arm vs lower arm), you can use the more specific V54.*xx*code. 

F Tessa Bartels, CPC, CPC-E/M


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## jvargocpc (Oct 24, 2008)

Thank you!!


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