Internal Medicine Coding Alert

Question: An established patient reports to the internist complaining of pain in her left index finger. One of our nonphysician practitioners (NPPs) examines the affected digit, diagnoses a mild sprain, and tapes it to the patient's left middle finger. Can I report 29280 for this encounter?

Arkansas Subscriber

Answer: Your NPP's actions do not constitute strapping in most payer's eyes, so leave 29280 (Strapping; hand or finger) off the claim. When a provider "buddy tapes" one finger to another, you should consider this an E/M service, most of the time. If you have any doubt about the payer's strapping procedures, check with the carrier before filing the claim.

Do this: When choosing an E/M code, consider all the NPP's actions during the encounter, including the buddy taping. So if the notes for the entire visit indicate a level-two service, report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) with 842.10 (Sprains and strains of hand; unspecified site) appended to represent the sprain.