Orthopedic Coding Alert

Question: A young athlete came into our office with a sprained elbow he received while playing soccer. Our orthopedist immobilized the elbow by strapping and splinting. What are the best codes to use for the application and removal of this kind of splint, and can we bill separately for the supplies?

Massachusetts Subscriber

Answer: The best code for reporting this particular procedure is 29105 (Application of long arm splint (shoulder to hand)). As for coding the removal, the general notes at the beginning of the Application of Casts and Strapping section in CPT^® explain that the removal is included in the procedure, so you do not need to use a separate code to document the removal.

The notes are also specific about billing for supplies. "If," CPT^® explains, "cast application or strapping is provided as an initial service ... in which no other procedure or treatment ... is performed ... by an individual rendering the initial care only, use the casting, strapping, and/or supply code 99070 in addition to an evaluation and management code as appropriate."

However, as 99070 (Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)) is a generic CPT^® code and many, if not most, carriers will not pay for this code, you should bill HCPCS codes A4570 (Splint) and Q4051 (Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)), as the HCPCS codes are much more specific and more likely toget paid.

Finally, to complete your documentation for the encounter, you'll report the appropriate evaluation and management (E/M) service per the CPT^® guidelines, adding modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). Choose an appropriate E/M code from the 99201-99215 based on:

• patient status: new or established;
• level of history the provider performs;
• level of examination the provider performs; and
• level of medical decision making (MDM) the provider performs.

You'll also need to choose the precise diagnosis code from the S53- (Dislocation and sprain of joints and ligaments of elbow) group, remembering to add the seventh character "A" to indicate that this is the patient's initial visit for ongoing treatment for the injury.