ED Coding and Reimbursement Alert

To ensure correct coding for the application of a splint by the emergency department (ED) physician, coders must check with their local carriers to determine what documentation is needed to bill for a splint if a physician orders it and then a nurse or technician applies the splint.

Many coders believe that splinting codes 29105 (application of long arm splint [shoulder to hand]), 29125 (application of short arm splint [forearm to hand]; static), 28126 ( dynamic), 29130 (application of finger splint; static), 29131 ( dynamic), 29505 (application of long leg splint [thigh to ankle or toes]) and 29515 (application of short leg splint [calf to foot]) cannot be used if the physician does not apply the splint. But coding experts disagree on whether a physician must physically apply a splint in the ED to bill for it.

If the physician must apply the splint to be permitted to code for it, it could be a problem for some. That rarely ever happens in our facility, explains Rebecca Bennett, RHIT, outpatient coder at Heartland Regional Medical Center in St. Joseph, Mo.

Jan Rassier, RN, the ED reimbursement coordinator for Edward Hospital in Naperville, Ill., codes for 18 physicians employed by the hospital. Im hearing two separate things. The experts are disagreeing. Some experts wont code for it [splint application], but others will, she says.

Rassiers approach accounts for Medicares stance on procedures not performed by the physician. I dont code Medicare patients for a splint application, Rassier explains. Medicare gets very prickly about paying for procedures that are not specifically done by the physician. I do code other payers, however. Its a service that I feel I can defend because there arent any hard and fast rules specifically that say the doctor must perform the procedure.

Addressing the Confusion

That lack of hard and fast rules is causing the confusion. But some of that confusion can be cleared up by Kenneth DeHart, MD, president and CEO of Carolina Health Specialists physician group in Myrtle Beach, S.C. DeHart is a former chair of the American College of Emergency Physicians (ACEP) coding and nomenclature advisory committee and a past member of the American Medical Association (AMA) CPT-4 editorial panel.

I was one of those responsible for the authorship of the amended splinting language, DeHart explains. When it was discussed behind closed doors at the CPT editorial panel, the issue was specifically discussed whether the physician needed to put the splint on or not. It was the consensus of the panel that it was not necessary for the emergency physician [...]