Internal Medicine Coding Alert

Question: An established patient who fell out of his bed while sleeping reports to the internist complaining of pain in his right wrist. In the course of 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?

Arizona Subscriber

- -----Answer: You should be able to report the strapping separately. According to Chapter 4, Section F of the Correct Coding Initiative (CCI) manual: "If a physician treats a fracture, dislocation, or injury with a cast, splint, or strap as an initial service without any other definitive procedure or treatment and only expects to perform the initial care, the physician may report an evaluation and management (E/M) service and a casting/splinting/ strapping CPT code."

------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 for the sprain

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

---- • 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low 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) appended to 99213 to show that the E/M and strapping were separate services

- -----• 842.00 attached to 99213 to represent the sprain

------• E884.4 attached to 99213 to represent the cause of the injury.

- ----- Remember: To get Medicare or Medicaid payment 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. (Private payers might also require physician involvement for this code; check with the payer if you don't know its specific policy on modifier 25.)