Primary Care Coding Alert

Question: A 12-year-old boy who gets in frequent fights smacked his short arm cast so much that the cast is ineffective. How should I code for my family physician replacing the cast?

Georgia Subscriber

Answer: You should use a cast and strapping application code to report the cast replacement. For a short arm cast, you should assign 29075 (Application, cast; elbow to finger [short arm]) with V54.89 (Other orthopedic aftercare) or V53.7 (Fitting and adjustment of other device; orthopedic devices). You may report the procedure even if your FP treated the arm fracture. The fracture repair codes include the initial casting and 90 days of aftercare.
 
Payers, however, may question the medical necessity of replacing the cast. So make sure that you include supporting documentation with the claim. The FP's notes should clearly explain why the physician had to remove the cast. For instance, your FP could explain that he had to replace the cast because the child had damaged it to the point that it no longer stabilized the injury.