# Splint coding



## karenmcgrady

I was sent this email from a coder at a local hospital. I do not handle facility coding so wanted to get some help for the correct answer.  Thanks

We treat patients in the ER and apply a splint to the finger or arm, the
nurse usually documents the application of the splint.

We bill a facility E&M level (nurse), 2 CPT procedure codes for
application of splint ( 1 for doctor and one for nurse).  We do not bill
a physician E&M level.

In cases that the physician clearly documents the application of the
splint, can we also bill the E&M physician fee along with charges form
above, or just leave the E&M physician level off since we are billing
the CPT procedure code twice?


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## Kimmers

karenmcgrady said:


> I was sent this email from a coder at a local hospital. I do not handle facility coding so wanted to get some help for the correct answer.  Thanks
> 
> We treat patients in the ER and apply a splint to the finger or arm, the
> nurse usually documents the application of the splint.
> 
> We bill a facility E&M level (nurse), 2 CPT procedure codes for
> application of splint ( 1 for doctor and one for nurse).  We do not bill
> a physician E&M level.
> 
> In cases that the physician clearly documents the application of the
> splint, can we also bill the E&M physician fee along with charges form
> above, or just leave the E&M physician level off since we are billing
> the CPT procedure code twice?



A: According to the Application of Casts and Strapping in the CPT book "_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 the fracture and/or dislocation codes. A temporary cast/splint/strap is not considered to be part of the preoperative care, and the use of modifier 56 is not applicable. Additional E&M services are reportable only if significant identifiable further services are provided at the time the cast application or strapping. If cast application or strapping is provded as an initial service (eg casting of a sprained ankle or knee) in which no other procedure or treatment (eg surgical repair, reduction of 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." _ 
You can't bill more than one E&M unless the services performed by the nurse and the physician are distinctly different from one another and in the case of a minor surgical procedure modifier 25 should be used the same day as the minor surgical procedure. Medicare scrutinizes the use of modifier 25. Here is Medicare's reference link http://www.cms.hhs.gov/regulations/

I hope this helps.


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## jimbo1231

*Procedures*

I also came over from many years on the physician side of the ED to the facility side. As you know, there is a great deal of documentation for physician ED coding both from the government and various experts in the field. But a lack on the facility side besides the ACEP Guidelines which are used in some facilities.
But as to ED facility side procedure coding, I'm wondering if anyone has reference materials to recommend. Also as to the above discussion, just want to throw three scenarios out there.

Doc applies splint   Can bill professional but not facility?

Nurse or tech applies splint. Can bill facility. But can't use splinting toward facility level?

Nurse/Tech applies; but doc documents checking the splint. At least for Medicare same as above. Can bill nurse/can't bill doc.

Is it me or do there seem to be a variety of approaches for facilites as to procedure and drug coding as to whether they are bundled into the level?

Thank You,

Jim CEDC  MCS-P


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## OCD_coder

karenmcgrady said:


> I was sent this email from a coder at a local hospital. I do not handle facility coding so wanted to get some help for the correct answer.  Thanks
> 
> We treat patients in the ER and apply a splint to the finger or arm, the
> nurse usually documents the application of the splint.
> 
> We bill a facility E&M level (nurse), 2 CPT procedure codes for
> application of splint ( 1 for doctor and one for nurse).  We do not bill
> a physician E&M level.
> 
> In cases that the physician clearly documents the application of the
> splint, can we also bill the E&M physician fee along with charges form
> above, or just leave the E&M physician level off since we are billing
> the CPT procedure code twice?



It is not appropriate to bill and E/M level for the nurse's splint application for the facility side.  E/M levels require an MD's training and skill.  There are great examples of what you can bill E/M levels for nursing visits in the back of your CPT book.

The facility should be billing the E/M for the physician as an MDM is required if this is ER billing.  Then the splint CPT code can be appended to that, with a 25 modifier appended to the E/M.  The nurse's work is captured in those codes.
e.g.  1) 99282-25, 2)  29125


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## slarimore

I am so confused on this subject. So if a patient comes to the ED with an injury to her finger. After evaluating her the physician decides the patient has a sprained intraphalangeal joint and orders a splint be applied to the patients finger. The nurse applies the splint and doctor checks the application. What would you charge? I think you would charge an EM level for hospital and EM level for physician as he evaluated the patient. Then you would charge for the Splint application also. If this is not correct can anyone please provide a link to where the rules can be found. Thanks!


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## bjw1980

I would charge for the application of the splint as well, but only once.  You can also code the application of a splint for premade splints- Hope this helps


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## Nancy Peavler

*Casting Conundrum*

I too work for an E.D. and do the facility coding portion. For several years we asked the same questions with conflicting responses from folks. The best guideline I have found so far is in an AHIMA atricle call "The Casting Conundrum" by Tanai Nelson, CCS, CCS-P.
Under the ED Visit heading is the following:
A patient is diagnosed with an ankle fracture in the E.D. The physician applies a short leg cast and refers the patient to an orthopedist. If the physician applies the cast, coders should report the code for the application of the cast. If the hospital staff applies the cast, the facility will report the same code. The facility should also charge for the supply, as appropriate.  If anyone finds anything from an Ortho group please let me know since we are still looking. My email nancy.buchanan@sjmc.org


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## laqbrown

*Splinting & Laceration Repair:  Facility versus Profee*

I'm still a little confused and want to make sure that I'm understanding this correctly.  I just started coding profee and facility charges for an ED facility.  

Scenario #1 - Facility Charges:  If a tech applies the splint, would you use the appropriate CPT code (i.e., 29125) for the actual application of the splint in addition the the HCPCS code for the supply and an E/M facility charge?  

Scenario #2 - Facility Charges:  How would you code the facility charges for a patient that comes in with a laceration of the hand and a physician does a laceration repair.  The ED facility where I'm working currently uses a point system to determine the E/M facility level and one of the line items is laceration repair. If this is accounted for under the facility E/M I presume that it would be "double dipping" if we also coded the CPT code for the laceration repair.  So, you would only be able to bill an E/M facility charge and not the 1000series CPT codes for the laceration repair in addition to the E/M facility charge.  Is that correct?  Does anyone see this differently?

Thanks in advance for your help.

LB


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