LCD/NCD Portal
Automated World Health
L28986
STRAPPING
02/02/2009
Indications and Limitations of Coverage and/or Medical Necessity
Strapping (Procedure codes 29540 and 29550)
• Medicare will consider Strapping of the ankle, foot and/or toe(s) medically reasonable and necessary for the following symptomatic conditions:
o Strains.
o Sprains.
o Dislocations.
o Tendinitis.
o Certain fractures not accompanied by ulceration.
Unna boot (Procedure code 29580)
• Medicare will consider the use of the Unna boot bandage medically reasonable and necessary for the following indications:
o To treat venous vascular insufficiency.
o For the treatment of ulcers with and without inflammation of the lower extremities which are caused by increased venous pressure, venous insufficiency or capillary dysfunction.
o For the management of sprains, strains, dislocations and minor fractures.
• It is not expected that Unna boot application would be done more often than once or twice per seven days.
• Unna boot application is not indicated for use with ulcers resulting from arterial disease or diabetes.
Coding Information
Bill Type Codes
• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.
• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.
• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12x Hospital Inpatient (Medicare Part B only)
13x Hospital Outpatient
21x Skilled Nursing - Inpatient (Including Medicare Part A)
22x Skilled Nursing - Inpatient (Medicare Part B only)
23x Skilled Nursing - Outpatient
74x Clinic - Outpatient Rehabilitation Facility (ORF)
75x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
85x Critical Access Hospital
Revenue Codes
• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.
• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.
• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0420 Physical Therapy - General Classification
0421 Physical Therapy - Visit
0422 Physical Therapy - Hourly
0423 Physical Therapy - Group
0424 Physical Therapy - Evaluation or Re-evaluation
0429 Physical Therapy - Other Physical Therapy
0430 Occupational Therapy - General Classification
0431 Occupational Therapy - Visit
0432 Occupational Therapy - Hourly
0433 Occupational Therapy - Group
0434 Occupational Therapy - Evaluation or Reevaluation
0439 Occupational Therapy - Other Occupational Therapy
0510 Clinic - General Classification
0761 Specialty Services - Treatment Room
CPT/HCPCS Codes
29540 STRAPPING; ANKLE AND/OR FOOT
29550 STRAPPING; TOES
29580 STRAPPING; UNNA BOOT
ICD-9 Codes that Support Medical Necessity
For CPT codes 29540 and 29550, the following diagnoses are considered medically reasonable and necessary:
718.37 RECURRENT DISLOCATION OF ANKLE AND FOOT JOINT
718.87 OTHER JOINT DERANGEMENT NOT ELSEWHERE CLASSIFIED INVOLVING ANKLE AND FOOT
719.27 VILLONODULAR SYNOVITIS INVOLVING ANKLE AND FOOT
726.70 ENTHESOPATHY OF ANKLE AND TARSUS UNSPECIFIED
726.71 ACHILLES BURSITIS OR TENDINITIS
726.72 TIBIALIS TENDINITIS
726.73 CALCANEAL SPUR
726.79 OTHER ENTHESOPATHY OF ANKLE AND TARSUS
727.06 TENOSYNOVITIS OF FOOT AND ANKLE
728.71 PLANTAR FASCIAL FIBROMATOSIS
733.93 STRESS FRACTURE OF TIBIA OR FIBULA
733.94 STRESS FRACTURE OF THE METATARSALS
733.95 STRESS FRACTURE OF OTHER BONE
735.0 HALLUX VALGUS (ACQUIRED)
735.1 HALLUX VARUS (ACQUIRED)
735.3 HALLUX MALLEUS
735.4 OTHER HAMMER TOE (ACQUIRED)
735.5 CLAW TOE (ACQUIRED)
735.8 OTHER ACQUIRED DEFORMITIES OF TOE
736.70 UNSPECIFIED DEFORMITY OF ANKLE AND FOOT ACQUIRED
736.79 OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT
824.0 FRACTURE OF MEDIAL MALLEOLUS CLOSED
824.2 FRACTURE OF LATERAL MALLEOLUS CLOSED
825.0 FRACTURE OF CALCANEUS CLOSED
825.20 FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) CLOSED
825.21 FRACTURE OF ASTRAGALUS CLOSED
825.22 FRACTURE OF NAVICULAR (SCAPHOID) BONE OF FOOT CLOSED
825.23 FRACTURE OF CUBOID BONE CLOSED
825.24 FRACTURE OF CUNEIFORM BONE OF FOOT CLOSED
825.25 FRACTURE OF METATARSAL BONE(S) CLOSED
825.29 OTHER FRACTURE OF TARSAL AND METATARSAL BONES CLOSED
826.0 CLOSED FRACTURE OF ONE OR MORE PHALANGES OF FOOT
837.0 CLOSED DISLOCATION OF ANKLE
838.00 CLOSED DISLOCATION OF FOOT UNSPECIFIED PART
838.01 CLOSED DISLOCATION OF TARSAL (BONE) JOINT UNSPECIFIED
838.02 CLOSED DISLOCATION OF MIDTARSAL (JOINT)
838.03 CLOSED DISLOCATION OF TARSOMETATARSAL (JOINT)
838.04 CLOSED DISLOCATION OF METATARSAL (BONE) JOINT UNSPECIFIED
838.05 CLOSED DISLOCATION OF METATARSOPHALANGEAL (JOINT)
838.06 CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT
838.09 CLOSED DISLOCATION OF OTHER PART OF FOOT
845.00 UNSPECIFIED SITE OF ANKLE SPRAIN
845.01 DELTOID (LIGAMENT) ANKLE SPRAIN
845.02 CALCANEOFIBULAR (LIGAMENT) ANKLE SPRAIN
845.03 TIBIOFIBULAR (LIGAMENT) SPRAIN DISTAL
845.09 OTHER ANKLE SPRAIN
845.10 UNSPECIFIED SITE OF FOOT SPRAIN
845.11 TARSOMETATARSAL (JOINT) (LIGAMENT) SPRAIN
845.12 METATARSAOPHALANGEAL (JOINT) SPRAIN
845.13 INTERPHALANGEAL (JOINT) TOE SPRAIN
845.19 OTHER FOOT SPRAIN
924.20 CONTUSION OF FOOT
924.21 CONTUSION OF ANKLE
924.3 CONTUSION OF TOE
959.7 OTHER AND UNSPECIFIED INJURY TO KNEE LEG ANKLE AND FOOT
For CPT code 29580, the following diagnoses are considered medically reasonable and necessary:
451.0 PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES
451.11 PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN (DEEP) (SUPERFICIAL)
451.19 PHLEBITIS AND THROMBOPHLEBITIS OF OTHER
451.2 PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES UNSPECIFIED
454.0 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER
454.1 VARICOSE VEINS OF LOWER EXTREMITIES WITH INFLAMMATION
454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION
454.8 VARICOSE VEINS OF LOWER EXTREMITIES WITH OTHER COMPLICATIONS
459.81 VENOUS (PERIPHERAL) INSUFFICIENCY UNSPECIFIED
707.10 UNSPECIFIED ULCER OF LOWER LIMB
707.11 ULCER OF THIGH
707.12 ULCER OF CALF
707.13 ULCER OF ANKLE
707.14 ULCER OF HEEL AND MIDFOOT
707.15 ULCER OF OTHER PART OF FOOT
707.19 ULCER OF OTHER PART OF LOWER LIMB
733.93 STRESS FRACTURE OF TIBIA OR FIBULA
733.94 STRESS FRACTURE OF THE METATARSALS
733.95 STRESS FRACTURE OF OTHER BONE
824.0 FRACTURE OF MEDIAL MALLEOLUS CLOSED
824.1 FRACTURE OF MEDIAL MALLEOLUS OPEN
824.2 FRACTURE OF LATERAL MALLEOLUS CLOSED
824.3 FRACTURE OF LATERAL MALLEOLUS OPEN
824.4 BIMALLEOLAR FRACTURE CLOSED
824.5 BIMALLEOLAR FRACTURE OPEN
824.6 TRIMALLEOLAR FRACTURE CLOSED
824.7 TRIMALLEOLAR FRACTURE OPEN
824.8 UNSPECIFIED FRACTURE OF ANKLE CLOSED
824.9 UNSPECIFIED FRACTURE OF ANKLE OPEN
825.0 FRACTURE OF CALCANEUS CLOSED
825.20 FRACTURE OF UNSPECIFIED BONE(S) OF FOOT (EXCEPT TOES) CLOSED
825.21 FRACTURE OF ASTRAGALUS CLOSED
825.22 FRACTURE OF NAVICULAR (SCAPHOID) BONE OF FOOT CLOSED
825.23 FRACTURE OF CUBOID BONE CLOSED
825.24 FRACTURE OF CUNEIFORM BONE OF FOOT CLOSED
825.25 FRACTURE OF METATARSAL BONE(S) CLOSED
825.29 OTHER FRACTURE OF TARSAL AND METATARSAL BONES CLOSED
826.0 CLOSED FRACTURE OF ONE OR MORE PHALANGES OF FOOT
837.0 CLOSED DISLOCATION OF ANKLE
837.1 OPEN DISLOCATION OF ANKLE
838.00 CLOSED DISLOCATION OF FOOT UNSPECIFIED PART
838.01 CLOSED DISLOCATION OF TARSAL (BONE) JOINT UNSPECIFIED
838.02 CLOSED DISLOCATION OF MIDTARSAL (JOINT)
838.03 CLOSED DISLOCATION OF TARSOMETATARSAL (JOINT)
838.04 CLOSED DISLOCATION OF METATARSAL (BONE) JOINT UNSPECIFIED
838.05 CLOSED DISLOCATION OF METATARSOPHALANGEAL (JOINT)
838.06 CLOSED DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT
838.09 CLOSED DISLOCATION OF OTHER PART OF FOOT
838.10 OPEN DISLOCATION OF FOOT UNSPECIFIED PART
838.11 OPEN DISLOCATION OF TARSAL (BONE) JOINT UNSPECIFIED
838.12 OPEN DISLOCATION OF MIDTARSAL (JOINT)
838.13 OPEN DISLOCATION OF TARSOMETATARSAL (JOINT)
838.14 OPEN DISLOCATION OF METATARSAL (BONE) JOINT UNSPECIFIED
838.15 OPEN DISLOCATION OF METATARSOPHALANGEAL (JOINT)
838.16 OPEN DISLOCATION OF INTERPHALANGEAL (JOINT) FOOT
838.19 OPEN DISLOCATION OF OTHER PART OF FOOT
845.00 UNSPECIFIED SITE OF ANKLE SPRAIN
845.01 DELTOID (LIGAMENT) ANKLE SPRAIN
845.02 CALCANEOFIBULAR (LIGAMENT) ANKLE SPRAIN
845.03 TIBIOFIBULAR (LIGAMENT) SPRAIN DISTAL
845.09 OTHER ANKLE SPRAIN
845.10 UNSPECIFIED SITE OF FOOT SPRAIN
845.11 TARSOMETATARSAL (JOINT) (LIGAMENT) SPRAIN
845.12 METATARSAOPHALANGEAL (JOINT) SPRAIN
845.13 INTERPHALANGEAL (JOINT) TOE SPRAIN
845.19 OTHER FOOT SPRAIN
Documentation Requirements
• Medical record documentation maintained by the performing physician must clearly indicate the medical necessity of the service being billed.
o In addition, documentation that the service was performed must be included in the patient’s medical record.
o This information is normally found in the office/progress notes, hospital notes, and/or procedure report.
• Documentation should support the criteria for coverage as set forth in the “Indications and Limitations of Coverage and/or Medical Necessity” section of this policy.
Utilization Guidelines
• Strapping (Procedure codes 29540 and 29550)
o It is not generally expected that strapping of the ankle, foot and/or toe(s) would be done more often than weekly.
o However, there are circumstances that warrant application of straps several times per week, such as, whirlpool treatments which require removal and reapplication of the straps.
• Hydrotherapy (whirlpool) treatment for decubitus ulcers is a covered service under Medicare for patients when treatment is reasonable and necessary.
o Some other methods of treating decubitus ulcers, the safety and effectiveness of which have not been established, are not covered under the Medicare program.
o Some examples of these types of treatments are: ultraviolet light, low intensity direct current, topical application of oxygen, and topical dressings with Balsam of Peru in castor oil.
• Unna boot (Procedure code 29580).
o It is not expected that Unna boot application would be done more often than once or twice per seven days.
Treatment Logic
• Strapping of the ankle, foot and/or toe(s) consists of the application of nonmedicated, adhesive gauze dressings, applied by overlapping wraps of gauze to exert pressure and hold a structure in place for the purpose of providing structural support, immobilization or compression for the ankle, foot and/or toe(s).
• Unna boot is a paste bandage which consists of gauze that has been impregnated with zinc oxide, gelatin, glycerin, and sometimes calamine.
o The bandage is applied to the leg from the toe to the knee by overlapping wraps of impregnated gauze.
o The Unna boot forms a semirigid soft cast which should be left in place for 4 to 7 days.
o The Unna boot bandage restricts the volume of the leg, controls edema, and encourages more normal prograde venous blood flow with reduction in the subcutaneous blood pressure.
o The net effect is improved healing of venous stasis ulcers of the lower extremities.
Sources of Information and Basis for Decision
American College of Foot and Ankle Surgeons. (2004). ACFAS Clinical Practice Guidelines [On-line]. Available: www.acfas.org
FCSO LCD 29314, Strapping, 02/02/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.
Sadovsky, R. (2003). Managing lower extremity venous ulcers. American Family Physician. [On-line]. Available: www.aafp.org/afp/20030815/tips/12.html
Wolfe, M.W., Uhl, T.L., Mattacola, C.G., and McCluskey, L. (2001). Management of ankle sprains. American Family Physician. [On-line]. Available: www.aafp.org/afp/20010101/93.html
Philadelphia (PA): Academy of Ambulatory Foot and Ankle Surgery. (2003). Heel spur syndrome. [On-line]. Available: http://www.guideline.gov/summary/summary.aspx?doc_id=4245
Schroeder, B. (2002). American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Heel Pain. [Electronic version]. American Family Physician, April 15, 2002.
AMA CPT / ADA CDT Copyright Statement
CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
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