ED Coding and Reimbursement Alert

Question: Must the doctor personally apply the splint during treatment of a fracture if the splint is the restorative treatment and the emergency physician is going to bill for fracture care?

Anonymous CA subscriber

Answer: There is much debate about the correct answer to this question. Many experts believe that the splint must actually be applied by the physician in order to bill for this service. However, Kenneth DeHart, MD, FACEP, former chair of the American College of Emergency Physicians (ACEP) advisory committee on coding and nomenclature and the colleges representative to the CPT editorial panel, disagrees. (See article, Understanding Clinical Terminology is Key to Choosing the Right Code for Repair of Fractures and Dislocations in the October 1999 issue of ED Coding Alert, page 73.)
DeHart advises that splint application can be reported if the physician documents the effectiveness that the physician achieves with the splint.
Although there are some payers who have gone one step forward unilaterally and said that they wont pay unless the physician places the splint himself, that is not the language we offered CPT, he explains.
However, in the above scenario, the physician would be reporting an orthopedic CPT code for fracture repair, and the application of the splint would be included in the code for the entire repair. A CPT code for splint application cannot be reported separately if the ED physician reports an orthopedic repair code.