Orthopedic Coding Alert

Answer: Many practices maintain similar arrangements with DME vendors that pay the medical practice fair-market-value rent to store an inventory of braces, orthotics, splints, etc., which the practice later dispenses to patients. Because most medical practices are not licensed DME suppliers, your practice cannot bill the DMERC directly for the supplies.

Although the DME vendor bills the patient's insurance carrier for all items dispensed, you can certainly bill for applying these products. For instance, if you fit a patient for orthotics and train him on how to properly use the product, you may report 97504 (Orthotic[s] fitting and training, upper extremity[ies], lower extremity[ies], and/or trunk, each 15 minutes).

"Dynamic splints are considered orthotics, and therefore the dynamic splint application service should be identified by code 97504," CPT Assistant states.

According to the Correct Coding Initiative (CCI), you can report 97504 in addition to an E/M code (99201-99215 for outpatient E/M visits). Documentation for 97504 must include the amount of time spent fitting the orthotic and instructing the patient in its use.

Anytime your practice prescribes a DME product, remember to fill out a certificate of medical necessity (CMN) completely, or you risk having the patient's claim for DME supplies denied.