EM Coding Alert

Question: A 10-year-old male patient presents to the emergency department (ED) for treatment of a fractured distal radius. The 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. The emergency physician documented a level-three ED E/M. Can I report cast application separately, even though the ED physician did not apply the cast, nor is there documentation that he “supervised” the cast application?

Massachusetts Subscriber

Answer: Medicare rules, and the rules of payers that follow Medicare, do not allow reporting casting services performed by someone other than the treating physician/provider, because the “incident-to” policy does not apply in the ED setting. On the claim, 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 service.

Exception: If a physician personally applies and adequately documents the application of a cast, then it’s appropriate to report a procedure code such as 29075 (Application, cast; elbow to finger [short arm]) or 29085 (… hand and lower forearm [gauntlet]).