Fractures, Dislocations, Casts, and Splints

Fractures and Dislocations

CPT codes 28400 to 28675 are the CPT codes specific for the treatment of fractures and dislocations.

They are all major surgical procedure codes with a 90 day postoperative global period.

Important Notes for Codes 28400 to 28675:

1.      1. Fracture and dislocation codes (28400-28675) include restorative or other procedures to treat the fracture or dislocation.
2.      2. The initial application of a cast is included in the fee and is subject to the 90 day Global Surgery Policy. You may bill for materials using the appropriate Q code which is for the materials used for the cast.
3.      3. Re-application of a cast during the follow up period is included unless medical necessity dictates otherwise. However, you may bill a Q code for the materials (to your carrier). After the 90 day postoperative global period, you may bill a cast application CPT code and Q code for the materials if appropriate.
4.      4. Refer to the National Correct Coding Edits (NCCI) for any CPT codes not payable with the fracture and dislocation CPT codes.

Cast Application Codes

CPT codes 29345, 29355, 29358, 29365, 29405, 29425, 29435, 29445, 29450 are the CPT codes for the application of casts and splints. They are all minor surgical procedure codes with a 0 day postoperative global period.

Important Notes for Codes 29345, 29355, 29358, 29365, 29405, 29425, 29435, 29445, 29450:

•     1. These cast application codes can be billed only if the application is performed to stabilize or protect the fracture, dislocation, or injury. No restorative treatment is performed. (Use codes 28400-28675 if restorative treatment is required). There is one exception. This entails the use of CPT code 29445, which is used in the treatment of diabetic ulcers.
•      2. For the Initial Injury Service:
•          a. Bill for the Cast Application Code 29345-29450
•          b. Bill an Initial E/M service code with the -25 modifier with the appropriate documentation to support a significant and separately identifiable E/M service.
•          c. Bill for materials using appropriate Q codes.
•          d. Removal of the cast is considered included in the cast application fee.
•      3. These cast application codes (plus a Q code) may be billed after the 90 day global period if a 28400-28675 fracture code was initially used.

Cast Material Codes

Q4030 Cast supplies for long leg cast Adult (11+ years) Fiberglass

Q4032 Cast supplies for long leg cast Pediatric (0-10 years) Fiberglass

Q4034 Cast supplies for long leg cylinder cast Adult (11+ years) Fiberglass

Q4036 Cast supplies for long leg cylinder cast Pediatric (0-10 years) Fiberglass

Q4038 Cast supplies for short leg cast Adult (11+ years) Fiberglass

Q4040 Cast supplies for short leg cast Pediatric (0-10 years) Fiberglass

Q4042 Cast supplies for long leg splint Adult (11+ years) Fiberglass

Q4044 Cast supplies for long leg splint Pediatric (0-10 years) Fiberglass

Q4046 Cast supplies for short leg splint Adult (11+ years) Fiberglass

Q4048 Cast supplies for short leg splint Pediatric (0-10 years) Fiberglass

Q4050 Cast supplies for unlisted types and materials

Q4051 Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding, and other supplies)

This is my opinion.

Michael G. Warshaw

DPM, CPC

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