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Ask the Expert

This month’s selection:
If a clinician only reapplies a small patch of the Unna boot, should that be a LOS instead of a whole Unna boot application code?

Jean Anne Jones, CPC, PCS
Senior coding education specialist
Harvard Vanguard Medical Associates

The CPT-4 code for an Unna boot procedure is 29580. Repairing an Unna boot does not meet the CPT-4 definition of 29580, and there is no separate CPT-4 code for repair of an Unna boot.

You can find the following guidance on page 13 of the April 2002 CPT Assistant, April 2002, Page 13. Please be aware that the intent of the CPT casting/strapping code series 29000 to 29799 is the same for both physician and outpatient hospital reporting. Therefore, codes 29000 to 29799 are used to report:

• a replacement cast/strapping procedure during or after the period of normal follow-up care;

• an initial service performed without restorative treatment or procedures to stabilize or protect a fracture, injury, or dislocation and/or to afford pain relief to a patient;

• an initial cast/strapping service when no other treatment or procedure (specific to that injury) is performed or expected to be performed by the same physician (eg, when placed by the emergency department physician).

Codes 20900 to 29799 are not used to report an initial cast/strapping service when the restorative treatment is performed (eg, surgical repair, closed or open reduction of a fracture or joint dislocation).

In the absence of being able to report a CPT-4 code for the Unna boot based on either the hospital’s present criteria for evaluation and management (E&M) assignment and/or the physician’s documentation of an exam, an E&M code could be assigned if documentation supports it.

Craneware is committed to providing its clients with the most authoritative, accurate, and trustworthy answers to questions like these to support their compliance with current regulatory guidelines. To that end, Craneware experts typically ask for further information to ensure the most efficient answer for the client’s specific circumstances. It is important to know the provider type, physician or hospital, which payer is referenced, and often details from operative notes, nursing, physician, and therapy notes, etc.

Otherwise, questions leave a lot of missing information that causes great speculation. The information provided here is of a general nature. Though these opinions are based on extensive industry experience serving more than 1,000 healthcare organizations of all sizes and grounded in the Centers for Medicare & Medicaid Services source documents indicated, they are not a substitute for consulting with a professional who is familiar with your healthcare organizations’ specific requirements. For further information, please visit www.craneware.com.

—Lamon Willis, CHCO, CPC-P, CPC-H, CPC-I, has more than 15 years of experience in outpatient coding and reimbursement in both hospital and physician services, revenue cycle, and practice management, is a healthcare consultant with Craneware, Inc, and is a certified coding instructor with the American Academy of Professional Coders.