Health Information Management

Q/A: Reporting L code and CPT code for splinting

APCs Insider, October 26, 2012

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q:  After a recent audit, an auditor provided us with provided education on the splinting codes along with the HCPCS Level II Codes for splints.  The auditor told us that we shouldn’t report the L code and the CPT® code. We always understood that splint application procedures are reported with the CPT code and the splint itself with the L code.  How should we report splinting procedures?

A:  You can report splinting procedures two different ways, depending upon whether the splint was custom made for the patient or prefabricated. 
“Custom” indicates that the physician or other provider created the splint specifically for the patient’s situation; these may be described as OCL® or fiberglass. 
Prefabricated splints are ones that are stored on the shelf and come out of the box ready to use. One example of prefabricated is a wrist splint that is applied with a Velcro strap tightened to hold the splint in place. 
The AMA created CPT codes in the 29xxx series to reflect physician/practitioner work expense of creating and applying customized splints.  While hospitals may report these codes to reflect the technical component of the procedure, coders need to consider the intent of the code.  Many prefabricated splints are described by a HCPCS Level II L-code. Read the full HCPCs code description as most of the L codes include the fitting and adjustment of the splint.  
Based on the code definitions, a CPT code and a HCPCS L code should not be reported together; otherwise, the application would be reported twice.
CMS published information about its APC policy for reporting HCPCS codes for orthotic devices in an April 2009 update. Transmittal 1702 states:
When hospital outpatient staff provide a prosthetic or orthotic device, and the HCPCS code that describes that device includes the fitting, adjustment, or other services necessary for the patient’s use of the item, the hospital should not bill a visit or procedure HCPCS code to report the charges associated with the fitting, adjustment, or other related services. Instead, the HCPCS code for the device already includes the fitting, adjustment or other similar services. For example, if the hospital outpatient staff provides the orthotic device described by HCPCS code L1830 (KO, immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment), the hospital should only bill HCPCS code L1830 and should not bill a visit or procedure HCPCS code to describe the fitting and adjustment.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular