Podiatry Coding & Billing Alert

Which procedure binds together? Which one functions as support?

When you come face to face with a need to report a splinting or strapping service, where do you look to for clues? Podiatrists often select splints and strapping depending on the patient's need and social/cultural environment. This service is often used in conjunction with therapeutic exercise, functional training and other interventions.

Nevertheless, billing a splinting or strapping procedure can be frustrating if you don't know how to distinguish between the two. Learn your way around splinting/strapping coding by reviewing this particular scenario:

A 60-year-old new female patient presents after falling off a five-step ladder. After a level-two E/M service and some radiology exams, the podiatrist diagnoses the patient as having closed fracture of the astragalus on the left foot. The physician treats the swelling by applying a plaster-molded splint to immobilize and protect the fracture. Then, she refers the patient to an orthopedic clinic for follow-up treatment in two days.

First, Scrutinize the 29000-29799 Code Set

You can't move forward with this case if you don't have any ideas on where to start. The best kickoff point is the CPT code set that describes splinting and strapping services: 29000-29799.

You can report a splinting or strapping code when the service is a replacement procedure (whether or not the physician provided definitive [fracture] care to the patient), according to Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Another situation that warrants a splinting or strapping code is the service is an initial service and the physician does not provide definitive (fracture) care to the patient, he adds.

Important: Make sure your claim meets these parameters. Otherwise, you can't choose a code from the 29000-29799 series. Remember, Medicare requires that you must prove that the device was applied by the podiatrist, not a nurse or other staffer. Commercial payers' guidelines may not follow that of Medicare, so it's always good to check with them first.

Consider the Value of Definition

Sometimes, you can find the best clue in the definition of terms that describe the procedure. For instance, check out this explanation of what a strapping is from a coding expert: Podiatrist apply it "to enhance performance of tasks or movements, support weak or ineffective joints or muscles, reduce or correct joint limitations or deformities, and/or protect body parts from injury," says Samuel A. Collins, an expert in chiropractic insurance billing and director of H.J. Ross Network, Santa Ana, Ca.

In short, a strap or tape, which typically involves the use of flexible material such as elastic wraps, heavy cloth, and adhesive tape, function as a tool to bind surfaces together.

On the other hand, a splint is a device -- usually made of wood, metal, plastic or plaster -- used for support or immobilization of limbs or of the spine (e.g., to stabilize fractures or sprains in the ER until follow-up appointment with a podiatrist or orthopedist).

Resolve the Scenario With 29515

You should code the given scenario as a splinting procedure:

• 29515 (Application of short leg splint [calf to foot])
• modifier LT (Left side) appended to 29515 to show that the physician performed the procedure on the left foot
• 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; straightforward medical decision-making) for the E/M
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99202 to show that the E/M and splinting were separate services
• A HCPCS code in the Q4XXX series for casting supplies
• 825.31 (Fracture of astragalus, closed) linked to 29515 and 99202 to represent the fracture
• E881.0 (Fall from ladder) attached to 29515 and 99202 to represent the cause of the injury.