# Splints - I do physician billing for a group



## Cindy Whitt (Nov 27, 2013)

I do physician billing for a group of ER doctors, and I have a patient that came in with a clavicle fracture.  The physician treated the fracture with a prefabricated figure 8 left clavicle splint.  What procedure code do you use for this?  Thanks for any help you give.
Cindy


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## armen (Nov 27, 2013)

I think in your case only E/M would be billed. You would not bill the fracture care either.

According to the American Medical Association CPT manual (2012 Professional Edition, page 142) reporting these services using an E&M code and the appropriate cast/splint application code (as applicable) is supported by the following statement: "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

Since the splint was not custom made, you would only bill for the L code, if splint was not provided by the hopsital of course.

CMS published information about its APC policy for reporting HCPCS codes for orthotic devices in an April 2009 update. Transmittal 1702 states:

When hospital outpatient staff provide a prosthetic or orthotic device, and the HCPCS code that describes that device includes the fitting, adjustment, or other services necessary for the patient's use of the item, the hospital should not bill a visit or procedure HCPCS code to report the charges associated with the fitting, adjustment, or other related services. Instead, the HCPCS code for the device already includes the fitting, adjustment or other similar services. For example, if the hospital outpatient staff provides the orthotic device described by HCPCS code L1830 (KO, immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment), the hospital should only bill HCPCS code L1830 and should not bill a visit or procedure HCPCS code to describe the fitting and adjustment.


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