Primary Care Coding Alert

Question: Our FP recently performed removal of a cast for a patient. So, should I report this procedure with 29700, or is there some other code for this? Should a separate E/M code be reported for the encounter?

Idaho Subscriber

Answer: You have not mentioned what your FP’s involvement was in the initial treatment of the patient when the fracture was reduced and a cast was placed. This is of utmost importance as your reporting of any procedures during the healing period and the cast removal is dependent on this.

Most fracture treatment codes have a 90-day global period. So, any further follow-up procedures or postoperative care or evaluation during this global period following the initial treatment of the fracture is included in the fracture treatment code that you are reporting in the initial fracture reduction and stabilization that was performed. For instance, if your FP had performed closed treatment of radial head or neck fracture that you reported with 24650 (Closed treatment of radial head or neck fracture; without manipulation), any care that was provided after the initial treatment of the fracture is included in the work involved in 24650 and should not be claimed separately. This includes removal of the cast.

So, you will not report the removal of a cast separately with another code such as 29700 (Removal or bivalving; gauntlet, boot or body cast) as this is also included in the global period following the fracture treatment. So, this removal should not be reported with another separate code. Also, any evaluation performed during this visit prior to the removal of the cast is also included in the global and should not be claimed for separately.

If your FP assumed fracture care after an emergency department physician or some other physician placed the cast, you should also report complete fracture care. In this case, even though your clinician didn’t place the initial cast, CPT^® still instructs you to use the global fracture code. Specifically, CPT^® guidelines preceding the casting and strapping codes state, “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.” As noted, the fracture care code includes all related 90-day postoperative care, such as periodic healing checks and evaluations and cast removal.

Likewise, if the FP placed the cast initially and reported that with a casting code, he cannot separately report the removal. The CPT^® guidelines preceding the casting and strapping codes also state, “Listed procedures include removal of cast or strapping.”

Per CPT^®, codes for cast removals should be employed only for casts applied by another individual. So, for example, you can report the removal of the cast separately with 29700 if your clinician was removing the cast placed by an emergency department physician and your clinician did not otherwise provide any of the fracture care.