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Bivalving a cast is a procedure that involves creating openings on both sides of a full arm or full leg cast. This technique is primarily employed to alleviate excessive pressure that may build up within the cast due to swelling or distension of the underlying body part. The procedure is performed using an oscillating saw, which is specifically designed to cut through the cast material and padding without causing harm to the skin or underlying tissues. The cuts are strategically made to ensure that the cast continues to provide adequate support to the injured area while allowing for necessary adjustments as swelling decreases. After the bivalving process, an elastic wrap is applied over the cast to maintain stability and can be adjusted as the patient's condition improves. In cases where the cast needs to be completely removed, the oscillating saw is again utilized to cut the cast on both sides, followed by the careful use of scissors to cut through the underlying padding and stockinette. Once the cast is removed, the skin is thoroughly inspected for any signs of breakdown or irritation, ensuring the patient's safety and comfort. It is important to note that specific codes are designated for different types of casts, such as 29700 for bivalving or removal of a gauntlet, boot, or body cast, 29705 for a full arm or leg cast, and 29710 for a shoulder or hip spica, Minerva cast, or Risser jacket.
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The procedure of bivalving or removing a full arm or full leg cast is indicated in specific clinical situations where the cast may be causing discomfort or complications due to swelling or distension. The following conditions may warrant this procedure:
The procedure for bivalving or removing a full arm or full leg cast involves several critical steps to ensure patient safety and comfort. The following steps outline the process:
After the procedure, the patient may be monitored for any immediate reactions or complications. It is essential to provide instructions regarding care for the affected limb, including keeping the area clean and dry. The healthcare provider may recommend follow-up appointments to assess healing and determine if further intervention is necessary. Additionally, the patient should be advised on signs of complications, such as increased pain, swelling, or changes in skin color, which would require prompt medical attention.
| Short Descr | REMOVAL/REVISION OF CAST | Medium Descr | REMOVAL/BIVALVING FULL ARM/FULL LEG CAST | Long Descr | Removal or bivalving; full arm or full leg cast | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 163 - Other non-OR therapeutic procedures on musculoskeletal system |
| LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | KX | Requirements specified in the medical policy have been met | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | F9 | Right hand, fifth digit | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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