ED Coding and Reimbursement Alert

Question: When an emergency department technician or a nurse applies a splint and then the physician checks the application, how should I report this? One of our physicians told me I could bill for checking the application in addition to the evaluation and management (E/M) code.

Delaware Subscriber

Answer: Because the physician did not personally perform the service, this would fall under the category of "incident-to" services. CMS is clear in its stance that the incident-to provisions do not apply to services performed in the ED. Because of this strict guideline, the ED physician would need to apply the splint personally in order for you to report the service to Medicare. For other payers, regional policies differ, but a post-splint check confirming adequate positioning and neurovascular status would represent a minimum level of physician involvement.

Best bet: Check with the carrier in question for a written policy on this issue.