Buckle Down With Strapping

CMS acknowledges the definition of strapping, bandaging and casting is causing multiple coding errors under the OPPS. While the finer points of strapping may be open to some debate, experts say the essential elements of strapping are fairly clear.
 
CMS' proposed rule describing OPPS 2002 changes, published in the Aug. 29 issue of the Federal Register, notes that codes grouped in APC 0058 (level I strapping and casting application) are not always appropriately billed by hospitals.
 
"The Advisory Panel on APC groups pointed out that code descriptors such as 'strapping of the hip' are not commonly understood by hospital staff," the rule states. "The Panel noted that before implementation of OPPS, hospitals billed the items described by these codes as supplies (without a CPT code) when they were billed as anything other than an emergency room visit. They stated that the use of these codes has been confused with the use of some codes associated with durable medical equipment."

What Is Strapping?

Stedman's Medical Dictionary defines a strap as "a strip of adhesive plaster." As a verb, strap means "to apply overlapping strips of adhesive plaster." Blair Filler, MD, director of medical education at Los Angeles Orthopedic Hospital, says the key to the procedure is that adhesive plaster is used. And, strapping requires skilled training in the application of numerous strips of adhesive and is usually performed by a doctor. 
 
Filler notes that strapping does not have to be applied to the skin. "You can apply an elastic bandage or Stockinet first and then apply the adhesive strapping over either. This is sometimes necessary when the patient is sensitive to tape. The object still is to immobilize the joint or limb," Filler comments.
 
Coders have been confused as to whether applying an Ace bandage alone an elastic bandage that is wrapped around an injury constitutes strapping. Because such a bandage is not an adhesive, by definition it does not qualify as strapping, whether the bandage is applied to the ankle or the hip, Filler says. The same is true for slings, aircasts, forearm or knee immobilizers, c-collars and postoperative shoes.
 
Strapping and bandaging are also reimbursed differently, Filler notes. Medicare will reimburse a facility for the cost of a bandage, but not for applying it. In contrast, Medicare pays for the application of strapping (29000-29799), but not for the straps themselves.

Immobilization Is Needed

Peter L. Sawchuk, MD, JD, MBA, chairman of the Coding and Nomenclature Advisory Committee of the American College of Emergency Physicians (ACEP), cites another definition. In addressing the issue, Sawchuk emphasizes that he was speaking for himself, not on behalf of ACEP.
 
Sawchuk cites the December 1998 issue of CPT Assistant, "A Comparative [...]

- Published on 2001-10-01