# Splint/Cast application



## hoobavent (Apr 1, 2013)

A patient comes in to see an Orthopedic Doctor who was referred by his PCP for consultation.  The patient has a finger fracture. The visit has Detailed History and Exam and im not sure yet with the MDM.  The orthopedic doctor decided to have a splint placed on his fractured finger.  A stack splint was given to the patient by the nurse.  Elevation and OTC meds were recommended for swelling and discomfort. Patient will be back for follow up.

How should I code for this visit?  I'm sure the application of splint do not apply here.  Can I bill for the Q-code for the splint itself and then a consultation code?


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## nyyankees (Apr 1, 2013)

hoobavent said:


> A patient comes in to see an Orthopedic Doctor who was referred by his PCP for consultation.  The patient has a finger fracture. The visit has Detailed History and Exam and im not sure yet with the MDM.  The orthopedic doctor decided to have a splint placed on his fractured finger.  A stack splint was given to the patient by the nurse.  Elevation and OTC meds were recommended for swelling and discomfort. Patient will be back for follow up.
> 
> How should I code for this visit?  I'm sure the application of splint do not apply here.  Can I bill for the Q-code for the splint itself and then a consultation code?



are you going to bill global surgical CPT or report via E/Ms?


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## hoobavent (Apr 1, 2013)

nyyankees said:


> are you going to bill global surgical CPT or report via E/Ms?



I'm not sure.  I did not even realize I have options.  Can you please explain this to me further since I'm new to orthopedic coding.


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## nyyankees (Apr 2, 2013)

hoobavent said:


> I'm not sure.  I did not even realize I have options.  Can you please explain this to me further since I'm new to orthopedic coding.



Sure if you use the Global Surgical code (i.e. 25550) you cannot report any casting/split charges (i.e. 29125) and the remaining CPT codes would be post-op 99024.

If you decide to report the fracture care via E/M codes (99213) you CAN capture the casting/splint codes. It all depends on how the doc wants to report. It's their choice.


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## hoobavent (Apr 2, 2013)

nyyankees said:


> Sure if you use the Global Surgical code (i.e. 25550) you cannot report any casting/split charges (i.e. 29125) and the remaining CPT codes would be post-op 99024.
> 
> If you decide to report the fracture care via E/M codes (99213) you CAN capture the casting/splint codes. It all depends on how the doc wants to report. It's their choice.



I know there are guidelines for reporting cast/splint applications.  Didnt it say that,

_Additional evaluation and management services are reportable only if significant identifiable further services are provided at the time of the cast application or strapping._.  

So my understanding is that we can't bill for both E/M and application of casts/strap not unless the provider took care of another problem the patient might have had at the time of visit.  I thought I can only code the E/M code for the visit and the supply code/s for any strap/cast/splint applied.  Can someone shed some more light to this?  The application of cast/splint/strap, does it have to be the M.D. that needs to perform this before we can even code the application?  Most of the time the doctor here just orders for this to be applied by either a nurse or someone else qualified other than him.


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## nyyankees (Apr 3, 2013)

hoobavent said:


> I know there are guidelines for reporting cast/splint applications.  Didnt it say that,
> 
> _Additional evaluation and management services are reportable only if significant identifiable further services are provided at the time of the cast application or strapping._.
> 
> So my understanding is that we can't bill for both E/M and application of casts/strap not unless the provider took care of another problem the patient might have had at the time of visit.  I thought I can only code the E/M code for the visit and the supply code/s for any strap/cast/splint applied.  Can someone shed some more light to this?  The application of cast/splint/strap, does it have to be the M.D. that needs to perform this before we can even code the application?  Most of the time the doctor here just orders for this to be applied by either a nurse or someone else qualified other than him.



That is the fallback of reporting E/M's for fracture care. As you replace a cast/splint it becomes very difficult to capture both cast + E/M. It all depends on how the doc wants to report. We used to put fee schedules together for our foot doc to see which was best to report. When I was at an Ortho Conference the foot doc stated that CPT directs you to choose the code that is most appropriate for the service provided. And as you know a 99213 does not best represent a fracture care. I brought this up to my docs but some felt better with E/M codes. There's some good articles on the AAOS website that help explain this better.


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