ED Coding and Reimbursement Alert

Plaster, fiberglass typically indicate splint use When a patient needing a splint or strap reports to the ED, coders must know the difference between the two, because their code choice will depend on it. The catch: Payer policies really don't provide much coding guidance on splinting and strapping. Because there are no universally accepted rules to direct you, what constitutes a splinting or strapping procedure is open to interpretation. However, we talked to some coding experts and got the lowdown on the most generally accepted coding procedures for splinting and strapping encounters. Use This Code Set for All Splinting/Strapping Claims You-ll use the 29000-29799 CPT code set to report splinting and strapping services, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Moore says you can report a splinting or strapping code when: - the service is a replacement procedure (whether or not the physician provided definitive [fracture] care to the patient); or - the service is an initial service and the physician does not provide definitive (fracture) care to the patient. "However, if the ED physician provides at least partial restorative care, report a fracture/dislocation orthopedic code. When reporting the fracture/dislocation codes, be sure to attach modifier 54 (Surgical care only) if the patient is being referred for follow-up care," says Sherry Milligan, CPC, coder at West Physician Services in Klamath Falls, Ore. Once you decide the encounter has met splinting/strapping parameters, you-ll next select a code from the 29000-29799 series. But in order to nail your selection down, you-ll need to know what your payers will consider a splint and what they-ll consider
a strap. Remember: In order to report splinting or strapping codes, you must prove that the physician was directly involved in the process, not solely a nurse or other staffer. Strapping definition: "Payers generally consider strapping the application of adhesive tape, one overlapping the other, to provide support and/or restriction of movement of ligament structures by exerting pressure upon the extremity or other area of the body," Milligan says. Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique, Milligan adds. Think of it this way: "A strap is something used to bind surfaces together or to give support or compress a body part (e.g., wrapping an ACE bandage around a sprained ankle)," Moore says. (Before coding an ACE bandage wrap as a strapping procedure, read "Bandages May Not Be Aces With Payers" on page 63.) Consider this example from Moore: A patient reports to the ED after slipping and twisting his ankle while jogging. During a level-three evaluation and management service, the physician diagnoses a sprained [...]