Orthopedic Coding Alert

Hint: Checking materials helps your claims.

A simple treatment like strapping could really get you entangled if you’re not clear on some coding fundamentals. Take these three steps to strapping coding success. 

Step 1: Understand Una Boot, Buddy Tape Definitions

Before you go ahead and assign a code for strapping, you’ll need to understand how your payer defines strapping. “Generally, payers consider strapping to be the application of overlapping adhesive tape to provide support or immobilization,” says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. Strapping may be done to support and/or restrict movement of ligament structures by exerting pressure upon the extremity or other area of the body.

“Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique,” says Betty Ann Price BSN, RN, President and CEO of PRCS, Inc. in Palmetto Florida. Your surgeon may often opt for strapping as a treatment for plantar fasciitis, ankle sprains, epicondylitis, DRUJ instabilities, and/or patellofemoral pain syndrome,” says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A.

Example 1: Unna boot application is one method of strapping. “Unna Boot application is the use of a calamine and zinc impregnated guaze in a layered fashion to apply compression, support and/or provide immobilization of the ankle or foot,” says Stumpf.  An Unna boot is a type of paste bandage.

The Unna boot bandage restricts the volume of the distal lower extremity, controls edema, and promotes venous blood return. The Unna boot is particularly useful for venous stasis ulcers or other venous insufficiencies of the leg, diabetic foot ulcers.” says Stumpf. You report Unna boot application with (29580, Strapping; Unna boot).

Don’t Forget to Report Boot Removal

A common mistake is to overlook the removal of an Unna boot. Check if the removal was done by same or another provider. “The application code 29580 is inclusive of supplies,” says Woodward. “The removal by the same provider is included in the application code,” says Stumpf.  “Removal of an Unna boot applied by another provider outside the practice may be reported using CPT^® code 29700 (Removal or bivalving; gauntlet, boot or body cast).”

Don’t forget: Confirm with your payer specific reporting guidelines for Unna boot removal. “Payers may have specifications for Unna boot removal. Majority of them may include it in the E/M service,” says Stumpf.

Be Specific for Strapping

Another example of strapping is buddy tape or ‘buddy splint.’ “Buddy straps are prefabricated straps made of canvas or foam and velcro,” says Woodward. You report codes 29280 (Strapping; hand or finger) or 29550 (Strapping; toes).

This strapping application typically involves wrapping tape around both an injured digit and an adjoining digit. ‘Buddy taping’ is the strapping of a digit to a neighboring digit for support of sprain/strains, or simple fractures. Although the treatment may be referred to as ‘buddy splint,’ the procedure is appropriately coded as strapping.

Bottom line: Clinicians use a strap to bind surfaces together or to give support to or compress a body part (e.g., wrapping tape around a sprained ankle). “Usually cast padding will be placed between the digits to absorb perspiration,” says Woodward. “Another use of buddy strapping is for support in flexible toe deformities to try to manually correct the deformity.”

Make sure you select the correct codes when your surgeon uses a buddy splint for digit fractures. “The practice may choose to bill for non-manipulative management in digit fractures,” says Woodward. You may report this with codes 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each) for the toe and 26720 (Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each) or 26750 (Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each). “Based upon current CCI guidelines, these could be reported only once if two digits are involved,” says Woodward.

Step 2: Look to Body Area for Code Selection

CPT^® arranges strapping codes by body area. Begin with code family 29000-29799 (Application of casts and strapping), then narrow your code choices by anatomic area (body, upper extremity, or lower extremity). Each anatomic section has options for splints, casts, and strapping. In particular, the strapping codes are in ranges 29200-29280 (body and upper extremity) and 29520-29590 (lower extremity).

Example: An established patient reports to your office after stumbling, falling, and hyperextending his ankle while walking his dog. During a Level 3 evaluation and management (E/M) service, the physician diagnoses a sprained ankle. The physician applies layers of web roll followed by adhesive tape to stabilize the ankle followed by application of an elastic bandage to the patient’s ankle and foot.

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

·         99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) to evaluate the injury, rule out additional injuries and manage pain as needed.

·         Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 to show that the E/M care and strapping were separate services.

·         29540 (Strapping; ankle and/or foot). Modifier LT (Left side) or RT (Right side) may be applied as appropriate to indicate the affected limb. “To bill this as strapping, make sure that the adhesive tape is applied in overlapping strips, exerting pressure over specific areas,” says Woodward.

·         CD-9 code 845.00 (Sprains and strains of ankle and foot; ankle; unspecified site) linked to 29540 and 99213-25.

·         ICD-9 code E885.9 (Accidental fall from other slipping tripping or stumbling) linked to 29540 and 99213-25. In both cases, E885.9 should be listed as the secondary diagnosis, says Kent J. Moore, manager of healthcare financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. Confirm if your payer accepts the E code before you report the same.

Plus: Note that the strapping codes include the subsequent removal of the strapping, Moore adds.

Step 3: Keep Up With Payers’ Supplies Guidelines

Payers support strapping when the physician has stabilized a joint with non-rigid materials allowing the patient to retain some range of motion, such as tape, web rolls and possibly an elastic (e.g., ACE) bandage. But the sole use of elastic bandages as strapping may be controversial among certain payers. Check with your payer to see if specific codes are applicable. “HCPCS codes A6448 – A6452 are the codes reported for ace bandages.  These HCPCS codes are based on the width and level of compression provided,” says Stumpf.

Preparation: Approach this issue by doing a little research with payers and creating a practice policy specifying which materials are appropriate to use for strapping.

Workaround: If the payer does not accept an elastic bandage wrap as strapping, then you will likely be limited to coding the appropriate level E/M office visit code. In this case, the payer may allow you to report 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]) in addition to the E/M code to capture the cost of the elastic bandage wrap, since such a supply is not usually part of an office visit.

Again, you will need to check with payer regarding its policy in this regard. “CPT^® code 99070 is a generic supply code that may be used to report the supplies, if the carrier does not recognize the standard HCPCS codes for the specific supply, or if a HCPCS code does not exist for a specific supply,” says Stumpf.  “A description should be listed on the HCFA form in box 19 to describe the supply used.”