Orthopedic Coding Alert

Question: When our provider removes a cast from a patient — boot, body, full arm/leg, shoulder, hip spica, etc. — can we report a CPT^® procedure code for the removal? Or an office evaluation and management (E/M) service?

Answer: Most likely not; you cannot report an E/M for this service, but there are some circumstances in which you can report these cast removal codes:

• 29700 (Removal or bivalving; gauntlet, boot or body cast)
• 29705 (Removal or bivalving; full arm or full leg cast)
• 29710 (Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.)

When? As CPT^® states: “Codes for cast removal should be employed only for casts applied by another individual.” So let’s say a patient reports for removal of a full left leg cast. The patient was on vacation skiing when he sustained the injury, and providers near the ski resort repaired and casted the leg. Report 29705 for the removal, with a note to the payer indicating that your practice did not perform the initial casting. Also, append modifier RT (Right side) to 29705 to indicate laterality, if the payer requires it.

Further, you cannot report an E/M for the service if your provider treated the patient and removed the cast. When this occurs, cast removal is bundled into the surgical package and not subject to separate coding.