Pediatric Coding Alert

And solve this encounter to sharpen your skills.

As simple as strapping and splinting procedures may seem on the surface, there are a number of key details that you should always keep in mind to ensure your claims stay clean and on point.

The following steps will help take you through all the guidelines and code choices you’ll need to accurately represent the procedures your pediatrician may use when a simple strapping and splinting encounter comes across your desk. And we’ve added a typical encounter that our experts have coded for you to round out your understanding of these common procedures.

Step 1: Remember These Key Guidelines

Before you use an Application of Casts and Strapping code from 29000-29799, you will need to make sure you are following CPT® guidelines to the letter. Importantly, you can only use the codes:

• “When the cast application or strapping is a replacement procedure used during or after the period of follow-up care”; and/or
• “When the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient.”

In other words, the only time you can use a code from 29000-29799 is when your pediatrician provides the initial cast or strapping or replaces one that has already been applied. No treatment procedure or any other kind of follow-up care must be involved, either before the application or after.

This is further reinforced by subsequent guidelines, which state that you must use the fracture and/or dislocation codes (27500-27566) when:

• “Restorative treatment or procedure(s) [is] rendered by another individual following the application of the initial cast/splint/strap”; and/or when
• “An individual who applies the initial cast, strap, or splint … assumes all of the subsequent fracture, dislocation, or injury care.”

Such circumstances are more likely encountered in an emergency department (ED) or orthopedic settings rather than in primary care.

In other words, “codes 29000-29799 are for the application of casts, splints and strapping, whereas 27500-27566 are for the treatment of fractures and joint injuries,” Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California, reminds coders.

“Codes 29000-29799 can be used on an initial claim if the service is performed without restorative care,” says Johnson. Or, to put it another way, “the cast and splint application codes should not be used if the clinician is planning to assume all of the care of the fracture,” according to JoAnne M. Wolf, RHIT, CPC, CEMC, coding manager at Children’s Health Network in Minneapolis, Minnesota.

“It is also important to note that strapping and taping are two different things,” Wolfe goes on. “The strapping codes 29520 [Strapping; hip], 29530 [Strapping; knee], 29540 [Strapping; ankle and/or foot], and 29550 [Strapping; toes] can be used when strapping is applied for immobilization common in the treatment of injuries such as sprains.”

You also have one other guideline to follow per CPT^®. If the encounter is an initial service, and the service is rendered with “no other procedure or treatment,” you should use 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)), to document the use of supplies such as tape or bandages.

Coding caution 1: Some coders regard 99070 as being too generic, as it does not specify which supplies a provider uses in a procedure. For more specific codes, turn to the HCPCS A codes, where you’ll find codes such as A6448 (Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard) that you can use in strapping and taping scenarios like the one below.

Coding caution 2: “During the initial treatment of the fracture or joint injury, the application of the first cast/splint/strapping is considered inclusive and not separately billable,” Johnson adds.

Step 2: Pinpoint the Correct Code From 29000-29799

Fortunately, code choices are relatively easy as the CPT^® codes are arranged first by anatomic area (upper extremity, lower extremity), then by procedure type (cast, splint, strapping). CPT® also lists eight other codes (29700-29799) for removal and repair.

Putting It All Together

Here’s a typical encounter for you to code: A patient reports to your office after stumbling, falling, and hyperextending her ankle. The physician diagnoses a sprained right ankle and 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.

“For diagnosis codes in this encounter, I would choose S93.401 [Sprain of unspecified ligament of right ankle] and W01.0XX- [Fall on same level from slipping, tripping and stumbling without subsequent striking against object],” notes Johnson. For both codes, you would add a seventh digit, A, to indicate that the patient encounter is initial.

As for the procedure codes, “you would use 29540 for the strapping of the ankle for immobilization,” says Wolfe, following step two above.

Don’t forget: You will also list the web roll, tape, and elastic bandage, per the code descriptor for 99070 and CPT^® guidelines, or appropriate HCPCS codes, “if it is expected that the patient will not be returning for additional care,” according to Johnson.