ED Coding and Reimbursement Alert

Question: A 10 year old presents to the ED for fracture of distal radius. ED physician orders X-rays, views the films, and order casting for support without reduction. The patient was sent to the “Cast Room,” where an orthopedic tech applied the cast. An EM level 99283 was reported by the emergency physician.

Since the ED physician did not apply the cast, nor is there documentation that he “supervised” the cast application, is it appropriate to assign the CPT^® code for casting?

Michigan Subscriber

Answer: Medicare rules do not allow reporting the casting services performed by someone else because the “incident-to” policy does not apply in the ED setting.

By Medicare rules, if a physician personally applies and adequately documents the application of a splint or strap, then it’s appropriate to report a splint/strap application procedure code.

Local payer rules are evolving and may vary regarding coding for direct supervision only. However, you would want to capture the costs associated with the casting on the facility side.