Internal Medicine Coding Alert

Tape, bandage wrap could indicate strapping

When a patient reports to the internist needing a splint or strap, coders need to be able to distinguish between the two because their coding will depend on knowing the difference.

What constitutes a splinting or strapping procedure? This question is open to interpretation, and there are no set guidelines to direct you. We talked to some coding experts, however, and got the lowdown on the most generally accepted coding procedures for splinting and strapping encounters.

 

Use This Code Set for All Splinting/Strapping Claims

You'll use the 29000-29799 CPT code set to report splinting and strapping services, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Moore says you can report a splinting or strapping code when:

• the service is a replacement procedure (whether or not the physician provided definitive [fracture] care to the patient); or

• the service is an initial service and the physician does not provide definitive (fracture) care to the patient.

Once you decide the encounter has met one of the above parameters, you'll next select a code from the 29000-29799 series. But to nail your selection down, you'll need to know what payers will consider a splint and what they'll consider a strap.

Remember: To report splinting or strapping codes to Medicare payers, you must prove that the device was applied by the internist, not a nurse or other staffer. With commercial payers, check their policies on splinting or strapping to see if they follow the same guidelines as Medicare.

Straps Bind Surfaces Together

To get an idea of what might constitute a strapping encounter, check out this experienced coder's opinion: "Payers generally consider strapping the application of adhesive tape, one overlapping the other, to provide support and/or restriction of

movement of ligament structures by exerting pressure upon the extremity or other area of the body," says Sherry Milligan, CPC, coder at West Physician Services in Klamath Falls, Ore.

Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique, Milligan says.

Think of it this way: "A strap is something used to bind surfaces together or to give support or compress a body part (e.g., wrapping an ACE bandage around a sprained ankle)," Moore says.

Consider this example from Moore: An established patient reports to the internist after slipping and twisting his ankle while jogging. During a level-two E/M service, the internist diagnoses a sprained ankle. The internist applies a two-foot, two-inch-wide ACE bandage to the patient's ankle and foot.

You should use a strapping code in this scenario. On the claim, report the following codes:

• 29540 (Strapping; ankle and/or foot) for the strapping.

• 845.00 (Sprains and strains of ankle; unspecified site) attached to 29540 to represent the sprain.

• E885.9 (Fall from other slipping, tripping, or stumbling) attached to 29540 to represent the cause of the injury.

• 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) for the E/M service.

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99212 to show that the E/M and strapping were separate services.

• 845.00 linked to 99212 to represent the sprain.

• E885.9 linked to 99212 to represent the injury's cause.

• 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) or A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 in., per yard) for the strap, depending on payer preference for supply coding.

Splinting Typically Involves Rigid Materials

Whereas straps are typically tape, bandages or some other flexible material, splints are made of harder stock. "Splinting is the application of a device made of wood, metal, plastic or plaster. Splints are used for stabilization, protection and the patient's comfort for an injury such as a sprain, fracture or dislocation," Milligan says.

Think of it this way: Splinting is "an application of an appliance used for the fixation, union or protection of an injured body part; it may be movable or immovable," Moore says.

Consider this example from CPT Assistant 2002: A 67-year-old new female patient presents after falling off a three-step ladder. After a level-two E/M service and review of radiographs, the physician determines that the patient has a nondisplaced fracture of the distal left ulna. Due to the swelling, the internist applied a plaster-molded splint to immobilize and protect the fracture. The physician then referred the patient to the orthopedic clinic for follow-up treatment in two days.

You should code this scenario as a splinting procedure:

• 29125 (Application of short arm splint [forearm to hand]; static) for the splinting.

• 813.43 (Fracture of distal end of ulna [alone]) linked to 29125 to represent the fracture.

• E881.0 (Fall from ladder) attached to 29125 to represent the cause of the injury.

• 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; straightforward medical decision-making) for the E/M.

• modifier 25 appended to 99202 to show that the E/M and splinting were separate services.

• 813.43 linked to 99202 to represent the sprain.

• E881.0 linked to 99202 to represent the cause of the injury.

• 99070 or A4570 (Splint) for the splint, depending on payer preference for supply coding.