Orthopedic Coding Alert

Question: My orthopedist saw a patient still under her global period for open reduction, internal fixation (ORIF) of humeral shaft/neck fractures. During the first post-op visit, the physician applied a posterior fiberglass splint from shoulder to just above the elbow. Should I use 29105 with modifier 52? Or is this service included?

South Carolina Subscriber

Answer: Yes, you should report 29105 (Application of long arm splint [shoulder to hand]) with modifier 52  (Reduced services). A cast or splint change during the global period is not part of the global package, and you can separately bill it. This is a new splint your physician is applying a day or more after the initial fracture management started.

Keep in mind: Some payers want modifier 58 (Staged or related procedure or service by the same physician  during the postoperative period) appended to the cast/ splint code, because these codes fall in CPT's  surgery section.

Don't forget supply codes, such as Q4017 (Cast supplies, long arm splint, adult [11 years +], plaster), Q4018 (Cast supplies, long arm splint, adult [11 years +], fiberglass), or 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]).