Health Information Management

Q&A: Coding for the supply when reporting splint application

JustCoding News: Outpatient, June 30, 2010

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QUESTION: When we give a patient a wrist or any other kind of splint to use when needed, can we bill supply code A4570? I read in HCPCS that dressings applied by a physician are included as part of the professional (evaluation and management [E/M]) service and that surgical dressings obtained by the patient to perform homecare as prescribed by the physician are covered. When a physician actually applies the splint to the patient while in the office, should we bill for the application with the appropriateCPT codes from code range 29105–29280 and 29505–29590? Is the supply included in the charge for the application?

ANSWER: Without more detail, the answer lies with the actual diagnosis and your specific definition of the term “splint.” In certain cases, a splint is deemed to be durable medical equipment (DME) rather than a dressing.

With regard to the code ranges you mentioned (29105–29280, 29505–29590), the guidelines in the 2010 CPT Manual are clear that you should not report these codes:

… if the cast application or strapping is provided as an initial service (e.g., casting of sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture, or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping, and/or supply code (99070) in addition to an evaluation and management code as appropriate.

In the HCPCS Level II Manual, there is a notation beneath code A4570 that states, “Dressings supplied by a physician are included as part of the professional service.”

In the 2010 CPT Manual, the last paragraph in the Medicine guidelines states, “Supplies and materials provided by the physician (e.g., sterile trays/drugs), over and above those usually included with the procedure(s) rendered are reported separately.”

So you should report code A4570 (and the like) when this splint or other supply is provided to the patient for use at home, per physician’s orders.

For example, if the patient had carpal tunnel syndrome and the physician showed the patient how to put on and take off the Velcro removable splint that the patient needs to wear only while sleeping, this service would be included in the E/M service code, and you could report the supply with code A4570 separately. In this case, the Velcro splint would be considered DME.

However, if the patient had a broken finger and after treating the fracture the physician applied a splint to the finger, the supply of the splint is already included in the fracture care procedure code.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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