Wiki Splints for facility vs physician

[breelogna]

Ok I've looked through a ton of threads in the ED forums and I've seen some conflicting answers. I do ED facility and profee coding but we're having a debate about the physician's side of splint billing.

Doc orders a splint be placed (clinician-made, not pre-fab). Nurse places the splint and documents a Splint Assessment. I KNOW I'm going to bill a splint code for the facility, but we're divided on whether to bill a splint code for the physician as well. On the one hand, the splint is documented as "CLINICIAN-made" and he puts the order in, on the other hand he didn't actually place the splint nor do I see any post-splint exam performed by the doc.

Is this just an issue of needing more documentation from the provider? How would you bill?

*Note, we are not billing for fracture care, no referral to ortho, no reduction, etc. Strictly just an E/M + Splint.

 

[keke74]

In this case, since the splint was applied by the nurse, it should not be billed on the ED Pro-fee side. The physician must directly apply the splint in order to bill on the Pro-fee side. This applies to most Medicare payers and those payers that follow Medicare guidelines. You could check with your MAC. Hope this helps!