How do you code a fracture follow-up visit where the cast is changed?

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How Do You Code a Fracture Follow-Up Visit When the Cast Is Changed?

— A Guide for Medical Coding Students

When a patient returns for a follow-up fracture visit and their cast is changed, you typically code this encounter as “subsequent care” using the ICD-10-CM injury code with the 7th character “D” (for routine healing), not a Z-code. Examples of such encounters include cast changes, X-rays to check healing, or removal of fixation devices.

For example:

• Fracture injury → code with the appropriate ICD-10 code ending in “D” for a subsequent visit.

• Do not use a Z-code (like Z47.89) for aftercare of fractures.

On the CPT side, remember that the initial global fracture care code already includes the first cast application. But if, during follow-up, the cast is replaced, you can bill separately for the cast re-application using the casting procedure code.

There are two main billing approaches:

1. Global fracture care method: Use a closed-treatment code (with or without manipulation) plus an E/M with modifier -57. Subsequent follow-up visits are included in the 90-day global, but you may bill separately for cast re-applications (with modifier -58) and supplies/X-rays.

2. Itemized method: Bill each visit separately — E/M (with -25), casting supplies, X-rays — for every encounter.

Stats & Context

• AAPC guidelines emphasize assigning the 7th character “D” for any aftercare during the healing phase, including cast changes and follow-ups.

• Industry recommendations highlight that the first cast application is included in the fracture treatment code, but subsequent casts must be billed separately.

Quality Thought:

Understanding these nuances—ICD-10 7th characters, correct use of modifiers, and the distinction between global vs. itemized billing—is essential for accuracy and compliance.

How our coding courses help educational students:

• We clarify these complex distinctions with real-world scenarios.

• Students perform hands-on coding practice with both ICD and CPT examples, including fracture follow-ups.

• We include Quality Thought modules that emphasize accuracy, documentation integrity, and ethical coding.

• Our Coding Course equips you to confidently navigate global billing, modifiers (-57, -58, -25), and ICD-10 extensions.

Conclusion

In fracture follow-up visits where the cast is changed, you assign the fracture code with a 7th character “D”, bill separately for the re-application of the cast (if applicable), and choose between global or itemized CPT methods depending on documentation and payer rules. With our Medical Coding Course and embedded Quality Thought emphasis, students gain the knowledge, skills, and confidence needed for precise, compliant coding. Are you ready to elevate your coding expertise and ensure quality in every code?

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