Podiatry Coding & Billing Alert

CPT® Coding:

Don’t Get in a Bind With Strapping and Splinting Claims

Published on Wed Oct 18, 2023

Focus on the materials used to simplify the process.

In instances where a patient presents to a podiatrist with an injury necessitating the use of a splint or strap, it’s crucial for coders to understand the difference between the two and ensure the appropriate codes are assigned.

Follow these three tips to stay on your toes when it comes to your casting and strapping claims.

Tip 1: Understand What Strapping Means

A strap is something used to bind surfaces together or to give support or compress a body part (e.g., wrapping tape around a sprained ankle). Payers generally consider strapping the application of adhesive tape, one overlapping the other, to provide support and/or restriction of movement of ligament structures by exerting pressure upon the extremity or other area of the body. Strapping requires specialized skill and knowledge of the anatomical structures as well as application technique.

A specific method of strapping is the application of an Unna boot, which you will code with 29580 (Strapping Unna boot). An Unna boot is a paste bandage which consists of gauze that has typically been impregnated with zinc oxide and may contain other emollients. The provider applies the bandage to the leg from the toe to the knee by overlapping wraps of impregnated gauze. This restricts the volume of the distal lower extremity, controls edema, and promotes venous blood return. The Unna boot is particularly useful for venous stasis ulcers or ankle sprain with severe swelling.

Another example of strapping is buddy taping or splinting using 29550 (Strapping; toes). This strapping application typically involves wrapping tape around both an injured digit and an adjoining digit to treat a toe sprain or fracture. While it may be referred to as a “buddy splint,” this procedure is appropriately coded as strapping.

Don’t forget: Another example of a strapping code you might use is 29540 (Strapping; ankle and/or foot). Per its descriptor, you’ll use 29540 when your podiatrist uses a strap to help stabilize an injury to a patient’s ankle or foot.

Tip 2: See How Splints Are Different

Whereas straps are typically combinations of tape, bandages or some other flexible material, splints are made of harder stock, such as metal, plastic, fiberglass, or plaster. Splints are used for stabilization, protection, and patient comfort for an injury, such as a sprain, fracture, or dislocation.

A few splint codes you may choose from are:

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

Like the strapping codes, the splint codes are distinguished by their anatomic location.

Use These Codes to Document Static Versus Dynamic Splints

The CPT^® splint codes don’t distinguish between the two different kinds of splints your podiatrist might use: static or dynamic. Instead, you’ll turn to the HCPCS Level II codes to document the specific splint type.

A static splint, which lacks any movable components, offers protection, immobilization, and stability for a recent injury. This type of splint is commonly used in emergency department (ED) settings. An example of a static splint code is E1831 (Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories).

On the other hand, dynamic splints, equipped with movable elements like hinges or springs, permit restricted movement and provide resistance, which can be beneficial during the rehabilitation process. Dynamic splints are considered durable medical equipment (DME). A few dynamic splint codes are:

E1815 (Dynamic adjustable ankle extension/flexion device, includes soft interface material)
E1830 (Dynamic adjustable toe extension/flexion device, includes soft interface material)

Remember this takeaway: Splinting is an application of an appliance used for the fixation, union, or protection of an injured body part; it may be movable or immovable. Provider documentation is the key to determine whether a strapping or splint application code is appropriate.

Tip 2: Research Types of Materials Payers Accept

Payers and clinical conventions support the use of strapping when the physician has stabilized a joint with non-rigid materials, such as tape, web rolls, and possibly an elastic (e.g. ACE) bandage, allowing the patient to retain some range of motion. However, the sole use of elastic bandages as strapping may get your claim denied by certain payers.

According to Medicare rules, to report splinting or strapping codes, documentation must support that the physician or a nurse practitioner (NP) directly participated in the application process.

If the payer does not accept an elastic bandage wrap as strapping, then you will likely be limited to coding the appropriate level evaluation and management (E/M) code rather than using a strapping or splinting code to ensure payment of your claim.

Coding scenario: An established patient reports to their podiatrist after stumbling, falling, and hyperextending their left ankle while riding their skateboard. During the visit, the physician diagnoses a sprained ligament of the left ankle after a short examination and obtaining a medically appropriate history. The physician 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. The entire encounter lasted 44 minutes: 33 minutes for the E/M and 11 minutes applying the strap.

You should use a strapping code in this scenario as the podiatrist wrapped the ankle and did not apply a splint of any kind. On the claim, you will report the following codes:

99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter) to evaluate the injury, rule out additional injuries and manage pain as needed
29540 (Strapping; ankle and/or foot). Modifier LT (Left side) may be applied as appropriate to indicate the affected limb
Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99214 to show the E/M and strapping were separate services
S93.402A, (Sprain of unspecified ligament of left ankle, initial encounter) linked to 29540 and 99214-25
V00.131A (Fall from skateboard, initial encounter) linked to 29540 and 99214-25

“The use of modifier 25 requires clear documentation that shows the physician’s thought process in providing the strapping that is over and above the required evaluation and management already included in the strapping code,” says Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC. Bella Vista, Arkansas.