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ED Coding and Reimbursement Alert

Reduce Denials for Splint and Strap Fracture Care

Published on Thu May 01, 2003

Call it splitting hairs, but you should know the difference between splinting and strapping and when you can report these services for your ED physician.

Clearly Separate Splints From Straps

Both splinting and strapping fall under 29000-29799 (Application of casts and strapping). Unfortunately, there is no definitive answer as to what separates the two, but here's some guidance.

You should decide, as a coding department, what differentiates splinting from strapping and apply your decision consistently when selecting codes, says Tammi Brame, CPC, compliance coordinator at Saint Elizabeth Physician Network in Lincoln, Neb.

Consider following one of these policies for reporting splinting versus strapping:

  • Option #1: Submit splinting codes if the physician immobilizes the joint, with a knee immobilizer for example, and report strapping if the physician stabilizes the joint. That's one way to divide these categories, Brame says.
  • Option #2: Choose splinting or strapping codes based on the level of expertise required to put the device on the patient, Brame says. If the application of the device requires the expertise of a physician or a nurse with extra training, a fiberglass splint for example, report splinting codes. If the ED technician taped the ankle, report a strapping code because that service requires less expertise, Brame says. Another indication of low expertise is that the patient can replace the device at home, she adds.
  • Option #3: Don't ever bill for the physician's application of prefabricated splints or straps. The idea behind this approach is that physicians shouldn't bill for applying Velcro products that you can just pull out of a box, Brame says.

    Look at Circumstances Before You Report

    If your physician applies the splint or strap, you're in the clear to report the service, but only if the following circumstances apply:

  • The physician must provide the initial splint or strap, or replace it.
  • The physician does not also provide definitive care, so you are not also reporting a fracture care code. (See "Break Bad Coding Habits With Fracture Care Answers" article 1, for more on definitive or restorative care.)

    You should request that your physician use an "I" statement in the medical documentation when indicating that he or she personally applied the splint or cast, says Eric Sandham, CPC, compliance educator at the Central California Faculty Medical Group in Fresno, Calif. This request makes sense from a compliance perspective. "Splint applied" doesn't make clear that a physician, not a technician, applied the splint and whether you can bill for the technician's work under the supervising physician is still an unanswered question, he says.

    Ask your payers whether you can report a cast, splint and strap code if the technician did the work under a physician. Expect that you may see denials based on the fact that incident-to rules which allow you to bill nonphysician practitioner work under supervising physician numbers do not apply in the ED, Sandham says.

    Do not report the application of an Ace wrap as a separate procedure, Brame says. Bundle that work into the E/M code, she says.

     

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