ED Coding and Reimbursement Alert

Question: A 9 year old presents to the ED for fracture of distal radius. ED physician orders X-rays, views X-ray, and makes the decision for casting without reduction. The patient was sent to the “Cast Room”, where an orthopedic tech applied the cast. An EM level 99283 was reported. 

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?

Delaware Subscriber

Answer: Medicare rules would not allow reporting the casting services performed by someone else because of the “incident to” policy not applying in the ED setting. 

If a physician personally applies and adequately documents the application of a splint or strap, then a splint/strap application procedure code may be utilized. 

Local payer rules may place limits on coding for direct supervision only. You are advised to confirm the acceptability of coding and billing for direct supervision of splint/strap application with these payers.

However, you would want to capture the costs associated with the casting on the facility side.