How To Use CPT Code 29435

CPT 29435 describes the application of a patellar tendon bearing (PTB) cast for the treatment of tibia and fibula shaft fractures. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 29435?

CPT 29435 can be used to describe the application of a patellar tendon bearing (PTB) cast. This cast is used to immobilize the lower leg and foot while allowing the knee to bend. It is commonly used in the treatment of tibia and fibula shaft fractures. The cast covers the lower leg and includes a segment in the front that comes up over the knee. The pressure applied to the fracture site stimulates bone growth as the patient walks.

2. Official Description

The official description of CPT code 29435 is: ‘Application of patellar tendon bearing (PTB) cast.’

3. Procedure

1. The healthcare provider positions the patient’s extremity with the knee bent.
2. Before applying the cast, the provider performs a complete neurovascular exam of the affected region to ensure proper circulation and nerve function.
3. The lower leg and foot are covered with stockinette, a loose knit fabric, to protect the skin from irritation.
4. Cotton or synthetic padding is applied over the stockinette to provide additional protection.
5. Wet casting material, such as plaster of Paris or fiberglass, is applied in strips over the padding to build up the cast.
6. The underlying stockinette is rolled over the openings in the cast to smooth out the edges.
7. The cast is allowed to dry, and then its fit is reassessed. If necessary, the provider trims the cast to ensure proper alignment and comfort.

4. Qualifying circumstances

CPT 29435 is typically used for patients with tibia and fibula shaft fractures who require immobilization of the lower leg and foot while allowing the knee to bend. The cast is designed to distribute weight through the patellar tendon, stimulating bone growth and promoting healing. The procedure is performed by a healthcare provider who has the necessary training and expertise in applying casts.

5. When to use CPT code 29435

CPT code 29435 should be used when a healthcare provider applies a patellar tendon bearing (PTB) cast for the treatment of tibia and fibula shaft fractures. It is important to ensure that the cast is specifically designed to allow the knee to bend while immobilizing the lower leg and foot. If the cast does not meet these criteria, a different CPT code may be more appropriate.

6. Documentation requirements

To support a claim for CPT 29435, the healthcare provider must document the following information:

• Patient’s diagnosis, specifically tibia and fibula shaft fractures
• Details of the procedure, including the application of the PTB cast
• Date of the procedure
• Any additional procedures or services performed in conjunction with the cast application
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 29435, ensure that the cast application meets the specific criteria outlined in the code description. It is important to accurately document the procedure and any additional services provided. Be aware of any specific guidelines or requirements from the payer regarding the use of CPT 29435. It is also important to consider the use of modifier 25 if an evaluation and management (E/M) service was provided on the same day as the cast application.

8. Historical information

CPT 29435 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider applies a patellar tendon bearing (PTB) cast to immobilize the lower leg and foot while allowing the knee to bend for a patient with a tibia shaft fracture.
2. A patient with a fibula shaft fracture receives a PTB cast application to promote healing and provide stability while allowing knee movement.
3. A healthcare provider applies a PTB cast to a patient with both tibia and fibula shaft fractures, ensuring proper alignment and weight distribution.
4. A cast technician applies a PTB cast to a patient’s lower leg and foot, following the healthcare provider’s instructions for immobilization and knee flexibility.
5. A healthcare provider applies a PTB cast to a patient with a tibia shaft fracture, carefully assessing the fit and making any necessary adjustments.
6. A patient with a fibula shaft fracture receives a PTB cast application, allowing for knee movement and weight-bearing while promoting bone healing.
7. A healthcare provider applies a PTB cast to a patient’s lower leg and foot, ensuring proper alignment and pressure distribution for optimal healing of a tibia shaft fracture.
8. A cast technician applies a PTB cast to immobilize a patient’s lower leg and foot while allowing the knee to bend, following the healthcare provider’s instructions for fracture management.
9. A healthcare provider applies a PTB cast to a patient with a fibula shaft fracture, providing stability and support while allowing for knee movement during the healing process.
10. A patient with both tibia and fibula shaft fractures receives a PTB cast application, promoting bone growth and providing immobilization while allowing for knee flexibility.