Pediatric Coding Alert

Question: Does the physician fee schedule assign global periods to the application of splint codes?

Colorado Subscriber

Answer: The splint application codes have zero global days, according to the Medicare Physician Fee Schedule, which private payers may adopt. For the second splint application, you can code another application, such as 29125 (Application of short arm splint [forearm to hand]; static) for applying a forearm splint.

Don't forget: On the original splint application day, you may report an E/M (99201-99215, Office or other outpatient visit ...) along with the splint application and casting supplies. If the physician reports a fracture treatment code, "this is global billing and the first casting application along with the removal would be bundled," explains Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Education in Boardman, Ohio. The E/M for the arm pain would have to be -- and probably would be -- significant and separately identifiable from the splint application and documentation would require appending the office visit Page 86 code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service).

Error averted: Check if your payer considers splint supplies durable medical equipment (DME). If it does, the insurer may not reimburse you for splint supply's cost. If the payer accepts Q codes for supplies, you can report Q codes for POS 11 (Office) every time your physician applies a cast -- even the initial treatment day, says Quita W. Edwards, CPC, CCS-P, COSC, CPC-I, billing director for ActionMed Administrative Solutions in Macon, Ga.

"Codes are based on the patient's age, the type of material (fiberglass or plaster), and the anatomical location." For day 1's encounter, you could have coded:

• 99201-99215 appended with modifier 25 with a diagnosis of arm pain (729.5, Pain in limb)

• 29125 for the application of arm splint -- also with a diagnosis of arm pain

• Q4021-Q4024 (Cast supplies, short arm splint ...) for the supply.