EM Coding Alert

Question: A 60-year-old presents to the emergency department (ED) and is found to have a fracture of the distal ulna after a fall. The physician orders x-rays, and after interpreting the films, decides to cast the forearm without reduction. The physician doesn’t apply the cast, however; an orthopedic tech casts the patient without physician involvement. Notes indicate a level-three ED E/M. Can we code for the E/M and the cast application?

Kansas Subscriber

Answer: Since the ED physician did not personally apply the cast, nor is there documentation that he “supervised” the cast application, it is not appropriate to assign a CPT® code or any additional work units for casting.

In your case, you should just consider the encounter an E/M service, and report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity) for the encounter.

Exception: Let’s say the physician does personally apply and adequately document the application of a splint or strap. In this case, you might be able to report a casting code such as 29125 (Application of short arm splint [forearm to hand]; static).

When you do report a splint/strap procedure in addition to the E/M, be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99283 to show that the casting and the ED E/M were significant, separately identifiable services performed by the same physician.