Pediatric Coding Alert

Increase your insight into laterality modifiers.

Spring is here, which means kids are heading outdoors. For coders, this means you may start to see an uptick in injury encounters as school athletes and rambunctious toddlers suffer sprains and minor fractures.

If you feel like your knowledge of coding for injuries requiring static or dynamic splints has gone dormant over the winter months, these scenarios should help you out.

See that Splints and Casts are Different

While splints can treat minor fractures, it’s important to understand that a splint and a cast are different.

Splint: A splint is most commonly used for minor fractures, sprains, tendon injuries, and other painful conditions where the patient experiences swelling and needs firm support in order to properly heal. Splints tend to be adjustable to allow for changes in swelling.

Cast: On the other hand, a physician will apply a cast for more serious fractures where the bone needs to be held in place. It is not adjustable, and it stays in place until the bone is completely healed.

Note: The coding for these services varies depending on whether you’re in a pediatric office versus an emergency room. The following information refers to minor injuries that a physician treats in the office.

Notice the Codes for Static Splints

Static: A static splint has no moving parts. Providers apply them to support and protect the patient, but also to correct an injury. There is also a variation called a serial static splint, which allows lengthening of the tissue by placing soft tissue at the end of its range of motion (ROM).

Scenario: Encounter notes indicate that the provider documented a hairline fracture and applied a static splint from a patient’s right hand up to the forearm.

Coding: The CPT^® codes for applying static splints are as follows:

• 29105 (Application of long arm splint (shoulder to hand))
• 29125 (Application of short arm splint (forearm to hand); static)
• 29130 (Application of finger splint; static)

The application code for this particular claim would be 29125, because the encounter notes say this was a static splint that extends from the hand to the forearm.

Pay Attention to Dynamic Splints

Dynamic: A dynamic splint does have moving parts. It allows for controlled movement of the injured area and is often used for injuries that require such movement to help restore proper function. It applies gentle force to that area to encourage movement while still providing support.

Scenario: A 16-year-old came into the clinic after a fall during a basketball game. He landed awkwardly on his right hand, and since then, he has been experiencing pain and difficulty moving his wrist and fingers. Upon examination, the provider noted swelling and limited range of motion in the wrist and fingers. An X-ray revealed a sprain in the forearm near the wrist. However, the teenager also had a previous history of limited hand mobility due to a past injury, for which he was still undergoing physical therapy.

Coding: The CPT® codes for applying dynamic splints are as follows:

• 29126 (Application of short arm splint (forearm to hand); dynamic)
• 29131 (Application of finger splint; dynamic)

The provider decided to apply a dynamic splint in order to allow healing but also provide controlled movement to the fingers and wrist. This would help prevent stiffness and aid in the ongoing rehabilitation of the hand’s mobility. The procedure code for this would be 29126, as this was an arm injury, not a finger injury.

Documentation alert: While you can often avoid a query by looking for keywords to help you identify whether the splint the physician used was dynamic or static, “if ever it’s unclear which code to use based on the documentation, it’s necessary to query the provider,” says Laidy Martinez, CPC, CGIC, CASCC, profee coder at Children’s Health of Orange County in Orange County, California.

Coding alert: The following codes are also for splints (lower extremities):

• 29505 (Application of long leg splint (thigh to ankle or toes))
• 29515 (Application of short leg splint (calf to foot))

The primary purpose of these codes is to differentiate between the anatomical location and complexity of the splint application rather than the specific type of splint, which is why the codes do not indicate whether the splint the provider has decided to use is static or dynamic. The decision to use static or dynamic splints in encounters involving these codes is not standardized protocol, and is instead dependent on clinical judgment:

Account for Laterality in Cases Involving Finger Splints

While laterality modifiers are not typically required for splint application codes, you’re likely to need to consider them when it comes to finger injuries.

Scenario: A 6-year-old was brought into the clinic by their parent after falling on the playground and landing on their left hand. The child is experiencing left thumb pain. Upon examination, the provider noted swelling and tenderness over the thumb and the child was unable to move the thumb without pain. An X-ray confirmed a fracture of the left thumb and applied a static finger splint.

The procedure code for this encounter is 29130. However, this will also likely require modifier FA (Left hand, thumb) to indicate the anatomical area of the splint. For fingers of the left hand, you’ll turn to modifiers FA – F4 (Left hand, fifth digit), and for fingers of the right hand, to F5 (Right hand, thumb) – F9 (Right hand, fifth digit). Similarly, you’ll append a modifier that falls between TA (Left foot, great toe) and T9 (Right foot, fifth digit) for splints on a toe.

Remember the Supply Codes

According to section guidelines, all services that appear in the Musculoskeletal System section include the application and removal of the first cast, but supplies may be reported separately. This means that in addition to the application codes, it’s possible the payer will also reimburse you for the splint itself. So, which kind of splint the doctor applied should be clear in the documentation.

Depending on the specifics of the encounter, you’ll need to select from the following supply codes:

• Q4021 (Cast supplies, short arm splint, adult (11 years +), plaster)
• Q4022 (Cast supplies, short arm splint, adult (11 years +), fiberglass)
• Q4023 (Cast supplies, short arm splint, pediatric (0-10 years), plaster)
• Q4024 (Cast supplies, short arm splint, pediatric (0-10 years), fiberglass)
• S8451 (Splint, prefabricated, wrist or ankle)
• A4570 (Splint)

Note: Each payer has different rules about reimbursing for splints, but it is still a good idea to submit the claim with codes for the supplies you used. You might be reimbursed, and a patient’s medical record should always be as specific as possible to ensure maximally effective care.

Guideline alert: Remember that 2022 saw a guideline change regarding splinting. “In 2022, CPT® revised the Musculoskeletal guidelines to discontinue separately reporting splinting for stability awaiting further evaluation,” explains Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont.