Primary Care Coding Alert

If you're wondering about reporting a fracture treatment and cast code for the same anatomic site on the same day, the latest edition of the National Correct Coding Initiative (NCCI) confirms that you shouldn't.
Fracture Care Codes Include Application Code
NCCI, version 9.2, effective Sept. 1, corresponds to CPT's guidelines, says Marie Felger, CPC, a family practice coding consultant and American Academy of Professional Coders certified coding instructor with Joy Newby & Associates LLC in Indianapolis. "The guidelines at the beginning of the musculoskeletal section and the application of casts and strapping subsection both clearly state that the treatment of fracture and/or dislocation codes (21300-28675) include the first cast, splint or strap application," she says.

Now NCCI is making the edits reflect this bundle, says Beth Glenn, CPC, CMA, certified coder for Jefferson Family Physicians in Jefferson City, Tenn. "The NCCI edits indicate that the application of casts and strapping codes are a component of the related comprehensive fracture code," Glenn says. Therefore, if you charge a fracture care code, you should not also bill a code for initial application of casts and strapping (29000-29590) associated with that fracture care.
Bill Either Treatment or Cast Code
Fortunately, because NCCI's bundle reinforces correct coding procedures, the new edit should not affect your practice's bottom line. The reason that both CPT and now NCCI disallow reporting a fracture care code with a related cast code is two-fold. First, the relative value units for fracture care and dislocation codes include the costs associated with the initial restorative treatment and all of the subsequent care for that condition during the global period, Felger says. Second, per CPT, the fracture service includes the initial cast, splint or strap. "Therefore, fracture care/dislocation codes and application of casts and strapping codes are mutually exclusive and not separately reportable," she says.

Fracture Bundle Example: A patient comes in with lower leg pain after falling off his bike during trail riding. He is unable to bear any weight on his leg. The family physician (FP) sends the patient for an in-office x-ray (73600, Radiologic examination, ankle; two views), which he interprets as showing a tibial shaft fracture (823.20, Fracture of tibia and fibula; shaft, closed; tibia alone). The physician treats the fracture (27750, Closed treatment of tibial shaft fracture [with or without fibular fracture]; without manipulation) and places a cylinder cast on the patient's leg (29365, Application of cylinder cast [thigh to ankle]). Because the fracture code (27750) includes applying the initial cast (29365), you should report the fracture treatment (27750), not the cast code (29365), according to CPT as well as NCCI.

Alternatively, suppose the FP does not treat the fracture and instead places a cast or strap to stabilize the [...]