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Orthopedic Coding Alert

You Be The Coder:

Which Codes Apply to an Ineffective Cast?

Published on Fri May 14, 2004

Question: An established 11-year-old patient hit his short arm cast so often that the cast became ineffective. How should we report the cast replacement?

Ohio Subscriber
 
Answer: 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]) with V54.12 (Aftercare for healing traumatic fracture of lower arm) or V53.7 (Fitting and adjustment of other device; orthopedic devices). You can report the procedure even if your physician initially treated the arm fracture.

But payers may question the cast replacement's medical necessity, so make sure you include supporting documentation with the claim. The orthopedist's notes should clearly explain why he had to remove the cast. For instance, your orthopedist could explain that the child damaged the cast so badly that it no longer stabilized the injury.
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