Pediatric Coding Alert

In the January article "Ethically Maximize Reimbursement for Fracture Treatment in a Primary Care Setting," on page 1 of Pediatric Coding Alert, we incorrectly implied that strapping and splinting supplies are included in 25600 (Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation) and 29125 (Application of short arm splint [forearm to hand]; static). Kay Faught, CPC, of Kay Faught CPT Coding and Clinic Management in Jacksonville, Ore., informed us that 29000-29590 "never include the supplies." Application of a cast or strap is included in these global codes, but the cast or strap is not, as per the CPT introduction to the application of casts and strapping section:

"If cast application or strapping is provided as an initial service (e.g., casting of a sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate."

Instead of the CPT supply code, HCPCS codes may be used instead. Regardless of which code you use, bill for the cast or splint supply, Faught urges. "Many clinics I have worked with make the error of not billing," she says, which results in lost revenue.

Coders may use two types of HCPCS codes that are specific to the supply A codes or the new Q codes:

1. A codes. With 25600 or 29125, you should bill for the supply with: A4570 Splint A4580 Cast supplies (e.g., plaster) A4590 Special casting material (e.g., fiberglass). 2. Q codes. "The beauty of the Q codes is that they're specific to the type of cast or splint used," Faught says. "That means you don't have to write in the amount it will be included in the code." Watch your payers for acceptance of these new codes:
  Q4009 Cast supplies, short arm cast, adult (11 years+), plaster
Q4010 fiberglass
Q4011 Cast supplies, short arm cast, pediatric (0-10 years), plaster
Q4012 fiberglass
Q4013 Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years+), plaster
Q4014 fiberglass
Q4015 Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster
Q4016 fiberglass
Q4021 Cast supplies, short arm splint, adult (11 years+), plaster
Q4022 fiberglass
Q4023 Cast supplies, short arm splint, pediatric (0-10 years), plaster
Q4024 fiberglass
Q4050 Cast supplies, for unlisted types [...]