Orthopedic Coding Alert

Question: A patient sprained his thumb MP joint while playing youth football. The orthopedist asked about the patient's medical history, examined the thumb and wrapped it with an ACE bandage to immobilize it. Which codes should we report?


Delaware Subscriber


Answer: Report 29280 (Strapping; hand or finger) with 842.12 (Sprains and strains of wrist and hand; metacarpophalangeal [joint]) for your surgeon's treatment of the sprained thumb. Some payers don't consider applying ACE bandages -strapping,- so ask the payer about its guidelines.

Remember to bill for the bandage the orthopedist used to wrap the thumb. Use code A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 in., per yard) to charge for the wrap.

Another tip: If the surgeon performs an x-ray of the patient's thumb, make sure you report the x-ray code (73120-73140).

You can also report an E/M code (99201-99205) for the office visit and attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

Modifier 25 will signal your payer that the E/M was separate from the sprain treatment and could prevent a denial.