ED Coding and Reimbursement Alert

Question: A patient who fell out of his bed while sleeping reports to the ED complaining of pain in his right wrist. During a level-three E/M service, the physician diagnoses a sprained wrist. The physician wraps the wrist in tape and covers it with an elastic bandage. Can I report a strapping code, or is the strapping part of the E/M service?

Oregon Subscriber

Answer: You should be able to report the strapping separately. Payers will allow you to report a strapping code when:

- the strapping is a replacement procedure or

- the strapping is an initial service to stabilize or protect an injury and/or to provide comfort to a patient and the physician does not provide fracture care to the patient.

Because this strapping is an initial service and the physician does not perform fracture care, you can code for it. On the claim, report the following:

- 29260 (Strapping; elbow or wrist) for the strapping

- 842.00 (Sprains and strains of wrist and hand; wrist; unspecified site) attached to 29260 to represent the sprain

- E884.4 (Other fall from one level to another; fall from bed) attached to 29260 to represent the cause of the injury

- 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of moderate complexity) for the E/M service

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99283 to show that the E/M and strapping were separate services

- 842.00 attached to 99283 to represent the sprain

- E884.4 attached to 99283 to represent the cause of the injury.

Remember: To get paid by Medicare or Medicaid for the strapping, you must show that the physician was directly involved in the process. If a nurse or other staff member straps the wrist, you cannot report 29260.