What should a practitioner do when the CPT decides to delete a code and there is no replacement nor similar procedure listed in the CPT? How should the procedure be billed? The code in question is 29590 (Denis-Browne splint strapping). CPT deleted the code effective January 1st 2013. The procedure still exists and can be performed if clinically appropriate on a child. See attached, Pre-2013, CPT illustrated guide to reimbursement for the aforementioned procedure. The procedure is complicated and labor intensive. Performing the procedure with the risk of it being rejected as 'Not Medically Necessary' or 'Non-Covered' by the plan, is not financially reasonable. Worse is the situation where the practitioner performs the procedure but does not get reimbursed and instead advised to begin the insurer's appeal process. This is also labor intensive and can take months of multiple levels of appeal, with no guarantee of reimbursement. One option might be to bill the procedure as CPT 29799 (Unlisted Casting or Strapping). This practitioner has trepidation in doing so, because most insurers deny 'Unlisted Codes' and require additional documentation to be submitted. Another option would be to perform the procedure and just include it in the overall 'Evaluation and Management' of the patient. This wound possibly affect the E&M's medical complexity or total time. This situation is further complicated when dealing with Managed Medicaid in NYS. Some codes like strappings are linked to certain diagnoses and may not be reimbursed on the Medicaid fee schedule. Moreover, these plans refuse to give a Pre-Determination (Organization Determination). As we know balance billing a Medicaid Beneficiary is prohibited unless certain criteria are met and the beneficiary is given 'Advance Notice, in writing. Your advice would be greatly appreciated.
One of the reasons a CPT® code may be deleted is that it becomes obsolete. That is what happened to CPT 29590 (Denis-Browne splint strapping) many years ago. The word "strapping" in that code descriptor is important in the explanation that follows.
When CPT 29590 was originally developed, a Denis-Browne splint was typically applied by "strapping," which involved taping the patient's feet to foot plates. However, over time, it became more common to use a Denis-Browne splint abduction brace, which eliminated the need for taping / strapping. With this evolution, the utilization of CPT 29590 decreased significantly, until finally the utilization became so low that it was deleted by the AMA CPT Editorial Panel. This may be an undesirable outcome for providers who still perform the traditional Denis-Browne splint "strapping" rather using a Denis-Browne splint abduction brace. There is no CPT code that specifically describes the traditional strapping of a Denis-Browne splint to a patient. If this service is performed today, the only coding option is to submit CPT® 29799 (Unlisted procedure, casting or strapping).
There are no RVU’s assigned to any “unlisted” CPT codes. Therefore, it is recommended that the following steps be followed when submitting CPT 29799:
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Certified Professional Coder
Certified Professional Medical Auditor
Lehrman Consulting, LLC
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