Orthopedic Coding Alert

Question: One of our doctors performed a closed reduction on a patients left wrist and applied a cast on 2/19/2009. The patient came into the ER on 3/02/2009 because of swelling, and another one of our doctors had to change the cast. What ICD-9 code should I use?

Tennessee Subscriber

Answer: You wont find any specific complications due to cast code. You might try using 998.89 (Other specified complication of procedures, not elsewhere classified).Private payers may pay for the ED visit with the complications diagnosis.

Another option is to go with 729.81 (Swelling of limb) in addition to the appropriate aftercare for healing fracture ICD-9 code. The reason is the encounter involved a cast change and the physician indicates the patient still has a healing fracture. Therefore, youll use a V54.xx code. For instance, use V54.12 (Aftercare for healing traumatic fracture of lower arm) for a traumatic fracture or V54.22 (Aftercare for healing pathologic fracture of lower arm) for a pathologic fracture.

Note: You should use a cast and strapping application code to report the cast replacement. For a short arm cast, you should assign 29075 (Application, cast; elbow to finger [short arm]). Payers may question the cast replacements medical necessity, so make sure you include supporting documentation with the claim. The orthopedists notes should clearly explain why he had to remove the cast.

Remember, Medicare would include the problem caused cast change in the fracture cares global. Carriers do not pay for complications that do not require a return trip to the OR.