ED Coding and Reimbursement Alert

Question: When can we code for splinting? Does the ED physician need to do a postapplication exam in order for us to code for splint application?


Florida Subscriber

Answer: Medicare does not recognize the "incident- to" provision in the emergency department, so in order to bill for splints for Medicare (and those payers following Medicare rules), the physician herself must directly apply the splint.

The incident-to provision allows physicians who employ nonphysician practitioners, such as nurse practitioners and physician assistants, to bill for the NPP's services. However, this rule applies only to office settings, so ED physicians cannot use it.

Private payers may have other rules, including recognition of splint services when the physician documents adequate supervision of the application, and a postsplint check, during which the physician addresses positioning and the patient's distal neurovascular status.