Wiki Off-the-Shelf Orthrosis/splint/brace

[Diana2032]

Good afternoon,

I’m looking to get some guidance, my provider an Orthopedic doctor normally performs application of splint/brace/orthosis at the office when seeing the patients. I am aware that we cannot bill for the application CPT code unless the splint/brace/orthosis is custom made and in the event the splint/brace/orthosis is an off-the-shelf item we should be billing for the HCPCS code instead in addition to the E/M code. I’m having a big dilemma because most of these items are off-the-shelf supplied by a third party company who bill for those separately therefore, my provider can’t bill for the HCPCS code, neither can she bill for the application because the items are off-the-shelf. My provider doesn’t feel this is right and we would like to know what else can she bill for in addition to the E/M code? I mean, she is applying the splint/brace/orthrosis himself and that takes time.

Any type of guidance will be kindly appreciated.

 

[golymom]

Probably your only option is to bill the therapy code 97760 which is primary for the education and training however the CPT code states it can also be used for fitting if not otherwise billed. This is a timed code so there needs to be documentation of the time spent doing the fitting and training as well as what training was provided (how to don and doff, wear time, skin care, precautions, etc). From a Medicare standpoint, this is a therapy only code so it will need the GP or GO modifier even if the service is being performed by the physician.

Medicare considers the fitting as part of the OTS orthosis charge but in your situation, you are not billing for the orthosis so they may allow it.

 

[tshortt0907]

application CPT

Good afternoon,

I’m looking to get some guidance, my provider an Orthopedic doctor normally performs application of splint/brace/orthosis at the office when seeing the patients. I am aware that we cannot bill for the application CPT code unless the splint/brace/orthosis is custom made and in the event the splint/brace/orthosis is an off-the-shelf item we should be billing for the HCPCS code instead in addition to the E/M code. I’m having a big dilemma because most of these items are off-the-shelf supplied by a third party company who bill for those separately therefore, my provider can’t bill for the HCPCS code, neither can she bill for the application because the items are off-the-shelf. My provider doesn’t feel this is right and we would like to know what else can she bill for in addition to the E/M code? I mean, she is applying the splint/brace/orthrosis himself and that takes time.

Any type of guidance will be kindly appreciated.

HI- Could you refer me to the documentation that states we cannot bill for the application CPT code unless the splint/strapping is custom made? This is in debate at my company, and I need the literature to support that this is not allowed.

 

[BLUCIANI]

Look to Closed Treatment Fracture care CPT codes.

Closed fracture are treated many ways ; With or WITHOUT manipulation, with or without traction (read the CPT manual for additional information).
Billing for fracture care has several options and each situation may pose billing issues depending on when the diagnosis was made and who is providing the restorative treatment.

Fracture care CPT codes carry a global of 90 days.

1) Global treatment=The provider may bill a mod 57 with the evaluation and management (E&M) service
which resulted in the decision for closed treatment of the fracture, or a 25 mod if the encounter included
a separate injury or separate diagnosis.

*In addition you may bill the closed treatment fracture care code from the 20000 section of the CPT.

* If you have provide DME you can bill this also, Many practices find it to expensive to keep stock for every
size and type of supply needed so they contract with DME suppliers.

2) The provider may bill itemized services without the fracture care CPT code allowing them to bill outside a
of a global of 90 day restriction.

*If you choose not to use the fracture care CPT, you may bill for each (E&M) visit in addition to any related services or supplies used for each visit.

NOTE:
Off the shelf splints were valued with the cost of the application built into the fee. That's why you would not bill for the application of an "off the shelf splint".

If you create a support splint using fiberglass or plaster, you are creating a custom product and you would bill for the application in addition to the supplies use to create the splint.

EXAMPLE:
E&M 99203-57 2.17 RVU
Closed treatment 25560 - 7.9 RVU closed treatment of a radial and ulnar fractures; without manipulation.
Application 29075- 1.79 RVU
Supplies Q 4010- cast supplies, short arm adult fiberglass.
A 6448 -ace wrap
A 4565 -sling

HCPCS NOTES:
bill supplies if your practice pays for the DME supplies. If you use a contractor for the DME they will bill the supplies and the application IF they applied the cast or splint but NOT the Closed treatment code.