Pediatric Coding Alert

Question: A pediatrician sees a patient to determine if her fracture has healed. His evaluation finds that the injury has healed sufficiently. Therefore, he removes her cast. Should I bill an E/M code in addition to the cast removal (29700)?

Washington Subscriber Answer: No, the pediatrician probably performed the evaluation and removal as part of complete fracture care. In this case, at the time of initial treatment, you should have reported the appropriate fracture care code, such as 27786 (Closed treatment of distal fibular fracture [lateral malleolus]; without manipulation). The evaluation and removal would fall under global fracture care. So, you shouldn't separately bill these follow-up services with the casting and strapping code that you mention (29700, Removal or bivalving; gauntlet, boot or body cast).

To make sure you select the right code series - fracture care or casting and strapping - check your role in the patient's fracture care and report the encounters using these methods:

1. If the pediatrician placed the initial cast, you should bill the global fracture code. The code includes 90 days of follow-up care including the healing evaluation and subsequent cast removal.

2. If the pediatrician assumed fracture care after an emergency department physician placed the cast, you should also report complete fracture care. In this case, even though the pediatrician didn't place the initial cast, CPT still instructs you to use the global fracture code. The code includes all related 90-day postoperative care, such as periodic healing checks and evaluations and cast removal.

3. If the pediatrician removes the cast due to damage, you should instead use the casting and strapping code (29700).