Podiatry Coding & Billing Alert

Tip: Get to know when you can code fracture care instead of just strapping.

With school starting again and student athletes becoming active, your podiatrist is sure to start to bring out the tape to treat injured toes and feet. In preparation, here are a few frequently asked questions and answers on strapping that may come up in your podiatry practice.

Q: What is the difference between strapping and “buddy taping”?

A: “Buddy taping” is one method of strapping your podiatrist might use. Strapping of toes — CPT® code 29550 (Strapping; toes) — is simply the application of adhesive bandages or strips to support the weak muscles in a toe. The physician applies elastic adhesive tape around the mid of the foot and several strips are attached to the toe. A locking strip is applied on the strip in the end. A proper fit with appropriate pressure is ensured for desired support and limitation of the body area. Strapping is used in treating strains, dislocations, sprains, and certain fractures.

In a buddy taping, the podiatrist tapes the injured toe to the toe next to it. A buddy taping would still be reported with code 29550.

Taping of the entire foot or ankle would be reported with code 29540 (Strapping; ankle and/or foot).

Q: What’s the difference between strapping and using an Unna boot?

A: Again, the Unna boot is another method of strapping, but it has its own CPT® code: 29580 (Strapping; Unna boot). The Unna boot is a spiral application of gauze, applied to the leg from the toe to the knee. A paste, usually of zinc oxide, is applied to the entire bandage.

Most payers will cover the procedure for a very limited number of diagnoses, including varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will accept additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19). Other possible diagnoses include edema (782.3) and lymphedema (457.1), says Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.

Q: When can I report 29550 and 20550 separately?

A: The Correct Coding Initiative (CCI) bundles 29550 into CPT® code 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]), meaning that Medicare considers strapping as part of the procedure. However, if the podiatrist performs the injection on a different anatomic area, you can report both procedures by appending modifier 59 (Distinct procedural service) to 29550.

Q: When can I report strapping separately from fracture care?

A: As with therapeutic injections, CCI considers strapping to be an intrinsic part of toe fracture care, and has bundled 29540 and 29550 into the fracture care codes (28400-28675, Fracture and/or dislocation procedure on the foot and toes). You can report the codes separately if the podiatrist performed the procedure on different anatomic sites. If he performed them on different feet, be sure to use append the LT (Left side) and RT (Right side) modifiers to both codes, along with modifier 59 to the column 2 code, 29550, to clarify the scenario for the payer.

Note that the fracture care codes carry more reimbursement than the strapping code alone, so if the podiatrist truly performed fracture care, he should receive full, fair reimbursement by reporting that code, and not the strapping code.

Example: A child comes in after stubbing her big toe. The physician looks at the X-ray, diagnoses a closed fracture (826.0), straps the toe to the adjacent one and tells the parent to have the child wear church shoes for a while for added protection. The physician reports no separate E/M service.

In this case, you have two options: 28490 (Closed treatment of fracture great toe, phalanx or phalanges; without manipulation), and 29550. By reporting fracture care with 28490, which has 4.13 RVUs and 90 global days, you’d be paid $147.95. On the other hand, 29550 has 0.88 RVUs and zero global days, which should pay you $31.52. A huge difference of $116.43 means you should go for 28490 rather than 29550.