Orthopedic Coding Alert

Question:  A new patient reports to the orthopedist with a closed fracture to the second digit on his left foot. The physician performs manipulation to realign the tip of the toe, and then buddy tapes it to the great toe. How should I code this encounter?

Wisconsin Subscriber  

Answer: If the physician provides restorative/definitive care for the patient’s broken toe, the service could be fracture care. Often, buddy taping is the definitive treatment for broken toes/fingers. This is not always the case, however, and you’ll have to code these encounters by case and payer.

Since the physician was treating a broken toe, and he provided definitive treatment, this might be a fracture care scenario. If you decide to go that route, report 28515 (Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each) for the fracture care.

Caveat: This encounter illustrates a potential 28515 scenario; there is, however, no formal guidance on buddy taping of toes, which means payers’ interpretation of the rule may differ.

Some coders report buddy taping of a broken toe as fracture care every time — provided the physician is caring for a broken toe.

Best bet: If you are unsure of a payer’s policy on buddy taping encounters, check to see what it considers definitive care for broken toes. Then the practice should create its own philosophy/policy on what constitutes definitive care for fractures.

Remember that not all buddy taping scenarios will result in a fracture care code. If the physician is treating a sprained or contused toe with buddy taping, be careful to avoid reporting a fracture care code. Without a fracture diagnosis, you cannot prove medical necessity for fracture care codes on a buddy taping encounter.

Best bet: Take the safe route and report a strapping code, such as 29550 (Strapping; toes).

E/M opportunity: Before your physician decides to buddy tape an injured toe, she will almost certainly perform a separate evaluation and management (E/M) service to decide on a treatment course. When you find evidence of a separate E/M in the notes, remember to include the appropriate level E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) or 57 (Decision for surgery) appended, depending on the global period of the procedure code.

X-ray opportunity: To check for fracture, the physician might also order toe X-rays. When this occurs, be sure to include 73660 (Radiologic examination; toe(s), minimum of 2 views) with modifier 26 (Professional component) appended if you are using another facility’s X-ray equipment.