Podiatry Coding & Billing Alert

Make sure you know when to report casting and strapping codes versus fracture/dislocation codes.

When you first read through the casting and strapping procedures in the CPT^® manual, reporting these services may seem deceptively simple. But, when you start going through all of the very specific rules you must follow from the guidelines, the CCI Policy Manual, and CPT^® Assistant, you soon learn that casting and strapping can actually be complicated

Read on to keep your casting and strapping claims in tip-top shape.

Tip 1: Always Follow These Casting and Strapping Guidelines

Before you report an application of casts and strapping code from the 29000-29799 range, you must first understand how the CPT^® guidelines instruct you to submit these codes. You can only report these codes under the following conditions:

“When the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient,” or

“When the cast application or strapping is a replacement procedure used during or after the period of follow-up care.” Note: “Although casting and strapping cannot be separately billed on the same date that an associated treatment (like a fracture reduction) is billed, it can be billed when the patient returns for follow up if the cast has to be replaced for any reason, like damage to the cast or need for a different size of dimension,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

The application of casts and strapping codes 29000-29799 can be used to report services when the physician is not planning to assume care for a fracture because surgery might be required or the care is out of their scope, explains Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. The physician may provide an evaluation and management (E/M) service and stabilize the injury.

If the cast or splint is applied because the ED physician confirms the facture but refers the patient to a specialist for fracture care, then you should bill the appropriate casting/splinting code (29000-29799) along with the appropriate E/M level, Falbo adds. You should append 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) to the facility E/M code.

Codes 29000-29799 represent the work to create the immobilization device, according to Falbo. Look for documentation of materials used such as stockinette, Webril, plaster, or fiberglass.

Bottom line: The only time you can use a code from the 29000-29799 range is when your podiatrist provides an initial cast or strapping or replaces one that has already been applied. No restorative treatment or procedure or any other kind of follow-up care may be involved, either before cast or strapping application or after.

Tip 2: Rely on Fracture, Dislocation Codes Instead in These Cases

In some cases, you should report fracture and/or dislocation codes (27500-27566) instead of the casting or strapping codes.

For example, “restorative treatment or procedure(s) rendered by another individual following the application of the initial cast/splint/strap may be reported with a treatment of fracture and/or dislocation code,” according to the CPT^® guidelines.

Also, the individual who applies the initial cast, strap, or splint and takes on all of the patient’s subsequent fracture, dislocation, or injury care should report a fracture and/or dislocation code, per the guidelines.

Don’t miss: “When performed, the initial cast, splint, or strapping is always included in the restorative treatment of fracture and/or dislocation codes,” according to CPT^® Assistant Vol. 28, No. 1. “Therefore, an individual who applies the initial cast, splint, or strapping, who will also report a code for the restorative treatment of the fracture on the same date of service, may not report a code for the application of a cast, splint, or strapping.”

Tip 3: Understand Multi-Layer Compression System Rules

When the podiatrist applies a multi-layer compression system (29581- 29584), this includes manual therapy in the anatomic region of the multi-layer compression system, according to the CCI Policy Manual. So, you should not report 97140 (Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes) for any type of manual therapy at the same patient encounter in the anatomic region where the podiatrist applied the multi-layer compression system.