Primary Care Coding Alert

Question: The physician fixed a patients fracture of the distal finger by placing the finger in a splint. If the splint immobilizes the fracture and therefore keeps it in proper alignment, is this considered fracture care and can I bill 26750? Should I bill for the splint and an E/M visit as well?

Connecticut Subscriber  
Answer: You can bill 26750 (Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each) for fracture care if the physician does not plan to refer the patient to an orthopedist for follow-up care of the fracture. The splint placement is included in 26750 and therefore cannot be billed separately. The  Application of Casts and Strapping (29000-29799) section in CPT 2002 states, A physician who applies the initial cast, strap or splint and also assumes all of the subsequent fracture, dislocation or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes. Assuming your doctors treatment of the patients fracture is the initial service, use 26750.
 
If the physician replaces the splint at a subsequent visit, report 29130 (Application of finger splint; static). Additional E/M services are reported only if they represent significant identifiable services provided at the time of the splinting. If the only documentation is for a fracture, reduction and splitting, separate services cannot be billed.