Primary Care Coding Alert

Question: Our physician recently saw a patient who reported to our practice with complaints of severe pain two days after he had a fall while skateboarding. Our clinician performed a level three E/M. Since he suspected a fracture, he ordered x-rays and upon assessment diagnosed the patient with fracture of the distal radius and decided to apply a radial gutter splint without any reduction. Can I report both the application of the cast as well as the E/M code for the encounter?

Vermont Subscriber

Answer: If your physician applied the cast, then you will have to report the application of the cast along with reporting the appropriate E/M code for the encounter. In this case, you have not mentioned whether your clinician only applied the cast or another orthopedic technician or another doctor performed application of the cast.

If another technician or clinician performed application of the cast, you can only report the E/M code for the encounter. If your clinician placed the cast and also performed the E/M service, you can report the application of the cast with the E/M code. Since a radial gutter splint was placed, you will have to report the application of the splint using29125 (Application of short arm splint [forearm to hand]; static).

Since E/M codes are bundled with 29125 according to Correct Coding Initiative (CCI) edits, you will need to use an appropriate modifier to overcome the edit bundle and report both the procedural code and the E/M code for the encounter. Since the E/M code is the column two code in the edit bundle, you will have to append the modifier to the E/M code that you are reporting for the encounter. The modifier that you have to append to the E/M code that you are reporting is 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).