Pediatric Coding Alert

Finger splinting, buddy taping, splinter removal increase revenue without requiring complex surgical work.

You could be missing out on opportunities to capture higher-paying procedure codes if you're overlooking reporting these splinting and foreign body removal codes.

Procedure 1: Collect $38 for Sport Injury Splinting

Pee-wee football's started up and with it the chance you'll see an increased number of patients with jammed fingers. "For a non-angulated finger, the pediatrician might fix the sprain, splint the finger, and send the patient home,"

notes Richard Lander, MD, a pediatrician and clinical assistant professor of pediatrics at University of Medicine and Dentistry of New Jersey. For the finger splint application, you could report 29130 (Application of finger splint; static), which contains 1.02 relative value units (RVUs) using the Resource Based Relative Value Scale. Although global fracture care codes include the initial cast or application, you may use the casting and splinting codes in addition to an appropriate E/M code (such as 99201-99215, Office or Other Outpatient Services) with modifier 25 (Significant and separately identifiable evaluation and management service on the same day of the procedure or other service) when you do not report a fracture treatment code.

Don't miss: For the history, exam, and medical decision making that led to the decision to splint the finger, you would report a significant separate E/M service appended with modifier 25. Since you are not reporting a global fracture care code, you may also code the x-ray (73120, Radiologic examination, hand; 2 views or 73130, ... minimum of 3 views).

Procedure 2: Use Taping Procedure Code to Add on $38

If a toe's broken, the pediatrician might buddy tape it to the adjacent toe and refer the patient to an orthopedist, Lander says. For the buddy taping, you could code 29550 (Strapping toes). The Medicare Physician Fee Schedule, which many payers adopt, assigns the code 1.04 RVUs. Report the history, examination and medical decision making preceding thedecision to buddy tape the toe with 99201-99215 appended with modifier 25.

For the x-ray, report 73600 (Radiologic examination, foot; 2 views) or 73610 (... complete, minimum of 3 views).

Procedure 3: Capture $227 on Splinter Removal

Removing a splinter from a patient's foot can net you approximately $227.

For instance, a pediatrician removes a 3 mm wooden splinter from a child's foot. Rather than including the work in an E/M code, you can report 28190 (Removal of foreign body, foot; subcutaneous), which has 6.15 RVUs.

Tip: Before using 28190, check that the documentation includes two details. The code require excising or opening to remove the foreign body."You have to say how and what you removed," Lander says. Proper documentation could read: "1 mm incision made with X, removed splinter." This entry meets 28190's requirements of incision and removal.