Primary Care Coding Alert

Question: On occasion, our physicians are called to the emergency department (ED) to see a patient with a broken bone. Usually, they apply a splint and have the patient schedule an office visit later in the week to apply a cast when the swelling has decreased. How should we code this situation?

Nebraska Subscriber

Answer: Under these circumstances, you may code for both encounters. Your practice should report the first code for the splint application in the ED. The appropriate code depends on the site of the fracture and can be found within CPT series 29000-29590 (e.g., 29125, application of short arm splint [forearm to hand]; static). Subsequently, if the patient returns for cast application and is going to follow up with your practice as well, you may report the appropriate global code for fracture care (e.g., 25500, closed treatment of radial shaft fracture; without manipulation).

Because fracture codes are considered global, they encompass normal follow-up care and cast removal. However, there are some situations where additional services may be billed. For instance, the patient described above returns two weeks later for a follow-up visit, which would typically be included in the fracture care global period. However, the cast is too loose and the physician determines it must be replaced. Because this is not considered standard care, the recasting should be reported, assigning a code from the 290xx Body and Upper Extremity/Casts series (i.e., 29075, application; elbow to finger [short arm]). This code would be appended with modifier -58 (staged or related procedure or service by the same physician during the postoperative period). A diagnosis code, in this instance, should be V54.8 (other orthopedic aftercare).

You Be the Coder and Reader Questions were answered by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City, Iowa; and Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians.