CPT® Code 29710

Official Description

Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.

Common Language Description

Bivalving a cast is a procedure that involves making incisions on both sides of a cast to alleviate excessive pressure on the body part that has been immobilized. This situation often arises due to swelling or distension of the affected area. The procedure is typically performed using an oscillating saw, which is specifically designed to cut through the cast material and the padding without causing harm to the underlying skin or tissues. The incisions are strategically placed to ensure that the cast continues to provide adequate support to the injured body part 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 swelling subsides. In cases where complete removal of the cast is required, 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. This procedure is specifically indicated for shoulder or hip spica casts, Minerva casts, or Risser jackets, and is distinct from other casting procedures that may involve different types of casts, such as gauntlets, boots, or full arm or leg casts.

1. Indications

The procedure of bivalving or removing a cast is indicated in specific situations where there is a need to relieve pressure or discomfort caused by swelling or distension of the immobilized body part. The following conditions may warrant this procedure:

Excessive Swelling The cast may become too tight due to swelling, necessitating bivalving to prevent further complications.
Discomfort or Pain Patients may experience significant discomfort or pain that can be alleviated by adjusting the cast.
Skin Irritation Signs of skin irritation or breakdown under the cast may require removal or adjustment to prevent further injury.
Monitoring Healing In some cases, the healthcare provider may need to inspect the healing process of the underlying injury.

2. Procedure

The procedure for bivalving or removing a cast involves several critical steps to ensure patient safety and comfort. The following outlines the procedural steps:

Step 1: Preparation The healthcare provider prepares the necessary tools, including an oscillating cast saw, scissors, and elastic wrap. The patient is positioned comfortably to allow easy access to the casted area.
Step 2: Bivalving the Cast Using the oscillating saw, the provider carefully makes cuts on both sides of the cast. These cuts are designed to relieve pressure while maintaining adequate support for the injured body part. The provider ensures that the saw does not come into contact with the skin.
Step 3: Application of Elastic Wrap After bivalving, an elastic wrap is applied over the cast. This wrap provides additional support and can be adjusted as the swelling decreases, allowing for continued immobilization without excessive pressure.
Step 4: Removal of the Cast If complete removal is necessary, the provider again uses the oscillating saw to cut the cast on both sides. Following this, scissors are used to cut through the underlying padding and stockinette, allowing for the safe removal of the cast.
Step 5: Skin Inspection Once the cast is removed, the provider inspects the skin for any signs of breakdown, irritation, or other issues that may have arisen during the casting period.

3. Post-Procedure

After the procedure, it is essential to monitor the patient for any signs of discomfort or complications. The healthcare provider may provide instructions on how to care for the skin following cast removal, including keeping the area clean and dry. Patients should be advised to report any unusual symptoms, such as increased pain, swelling, or signs of infection. Follow-up appointments may be scheduled to assess the healing process and determine if further treatment or immobilization is necessary.

Short Descr	REMOVAL/REVISION OF CAST
Medium Descr	RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET
Long Descr	Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.
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)	0 - 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

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).
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.
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.)
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)