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Internal Medicine Coding Alert

Reader Question:

Location of Cast Determines Removal or Bivalving Code Choice

Question: Presenting complaint: Patient states that he was scratching inside of his full long leg cast with a hanger when the hanger broke off and is now stuck in cast.

The procedure note reads: Foreign Body Removal: after bivalve of the cast and cutting through padding and stockinette, I removed piece of plastic. The broken edges match those of the hanger brought in. There does not appear to be another piece of plastic in the cast and the skin in that area was intact.

What is the procedure code for the removal?

Maryland Subscriber

Answer: You will need to report a code from the CPT® range 29700-29750 when your physician performs removal or repair of a cast. But, you can report a code from this range only when the cast has been applied by another individual. The following codes are available for reporting cast bivalving services:

  • 29700 (Removal or bivalving; gauntlet, boot or body cast)
  • 29705 (Removal or bivalving; full arm or full leg cast)
  • 29710 (Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.)

Codes 29720–29750 are reserved for repair, windowing a cast, or wedging of a cast.

In the case scenario that you have described, you will need to report 29705 as the cast that your physician bivalve to remove the foreign body was a full leg cast.