Pediatric Coding Alert

Question: A patient breaks one of his toes (826.0, Fracture of one or more phalanges of foot; closed), and the definitive care is therefore buddy taping. How should I code for the buddy taping?


Illinois Subscriber


Answer: You can actually report the buddy taping with 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each). Using the CPT procedure code will pay you about $104.60 (2.76 relative value units using the 2006 National Physician Fee Schedule conversion factor of 37.8975) as opposed to $52.68 for 99213 (1.39 total nonfacility RVUs).

Don't rule out: Using 28510 for the buddy taping doesn't mean you can't also report an E/M service for the encounter. Look at what kind of decision-making went into the visit. When the child first presented, you probably made a decision about how to handle the fracture, what kind of treatment it required, and how you are going to manage the care. For these elements, you should report an E/M service.
 
To indicate that the E/M service is significant and separate from the fracture care, use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M service code.

When the patient returns for follow-up care related to the fracture, you should not use an E/M code. Visits for follow-up care should be coded with 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure) and no additional charge made.

Code 28510 includes 90 global days.