ED Coding and Reimbursement Alert

Question: A patient came to our emergency department complaining of ankle pain after falling off a curb. During a level three ED E/M service, the physician diagnosed a sprained ankle. The physician applied layers of web roll followed by adhesive tape to stabilize the ankle followed by application of an elastic bandage to the patient's ankle and foot. Is this strapping or splinting?

Codify Subscriber

Answer: 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. Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique.

Whereas straps are typically combinations of tape, bandages or some other flexible material, splints are made of harder stock. In short, splinting is the application of a device made of rigid material including metal, plastic, fiberglass or plaster. Splints are used for stabilization, protection, and patient comfort for an injury such as a sprain, fracture, or dislocation.

You should use a strapping code in this scenario. On the claim, report the following codes:

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of moderate complexity...) to evaluate the injury, rule out additional injuries and manage pain as needed.
• Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99283 to show the E/M and strapping were separate services.
• 29540 (Strapping; ankle and/or foot). Modifier LT or RT may be applied as appropriate to indicate the affected limb.
• ICD-10 code S96.919A (Strain of unspecified muscle and tendon at ankle and foot level, unspecified foot, initial encounter)
• ICD-10 code W10.1XXA (Fall [on] [from] sidewalk curb, initial encounter)