Strapping/ Splints etc.

[Guest guest]

Thought that many of you might be interested in this article / Q & A.

The direct link to this information is:

http://www.himinfo.com/apcezine/ezine_arc.cfm?volume=3 & issue=6

APC Monitor Archive

February 8, 2002

----------------------------------------------------------------------

----------

Casting/Splinting and Ace Bandage tips

No. 6

Q:

A: APC Monitor has received numerous questions concerning hospital

coding and billing of splinting, strapping and casting codes. The

latest question received asked if Ace Bandage application is

considered strapping/casting/splinting? If so, how should it be coded?

Another reader asked how to code immobilizations. Another asked about

the requirement for a performing physician in the HIM abstract module

for CPT codes in the 10000-69999 code range where

strapping/casting/splinting procedure codes fall.

This is a subject that continues to cause a lot of difficulty for

coders. CMS' APC Advisory Panel met last month in Baltimore and

discussed the need for CMS to issue a program memo that spells out

very clearly what the rules are for strapping, splinting, and casting

services. There will continue to be questions and problems with this

entire subject until CMS steps up and tells us exactly how to handle

these kinds of cases.

That being said, we hope the following information will be helpful as

you decide how to apply codes. There's a lot of information here, so

please take the time to read it thoroughly. Contact your FI for

additional information applicable to your facility.

First, some basics. Hospitals should report all services performed on

registered outpatients during an encounter at the hospital. Covered

services are represented with CPT and HCPCS procedure codes when

medically necessary, documented properly and performed by

credentialed healthcare personnel under appropriate coverage

requirements (physician supervision, limited diagnostic conditions,

etc.).

Splinting/strapping/casting services should be reported by hospitals

when performed by the physician or when performed by credentialed

healthcare personnel (credentialed means the personnel are practicing

healthcare under their State Scope of Practice - e.g., RN, LPN,

physical therapy [PT], occupational therapy[OT], etc.). Services must

be ordered if not personally performed by a physician or allied

health professional (NP, PA, CNS) and thoroughly documented.

HIM departments should use the appropriate CPT procedure codes to

indicate services performed. The codes may already be listed in the

facility chargemaster. The UB-92 requires that the name and UPIN

number of the ordering or performing physician be reported in form

locator 82 on the claim. Requirements for a performing physician for

all services in code range 10000-69999 for HIM abstracting is not a

Medicare billing or coding requirement. This is an hospital/HIM

information systems issue.

Here are definitions of splinting/strapping/casting that will help

answer questions about immobilization and ace bandage application.

Casting is the immobilization of an affected joint. It is a labor-

intensive process, requires training, and is essentially a

fabrication of a specialized, customized device, that is molded to a

specific patient.

Strapping is customized reinforcement and support for ligament

structures through restriction of movement for increased

stabilization. It requires specialized knowledge not only of the

structures being strapped but also of the method of applying the

strap for the best support of these structures.

Splinting is the application of an appliance of wood, metal, plastic

or plaster used for fixation, union or protection of an injured part

of the body.

Applying a post-op shoe, sling, or general ace bandage application

techniques typically do not rise to the level of casting, strapping,

or splinting. Applying a sling is a first-aid technique. Normal ace

bandage application techniques are also first-aid.

Applying a post-op shoe, sling, or general ace bandage application is

not separately reportable from the E/M visit code, but may be

considered in determining the facility (ER/clinic) visit level charge.

The post-op shoe itself may be listed separately as a supply if it is

applied at the direction of a physician (written order) and is

medically necessary. Listing the post-op shoe separately does not

simply extra payment outside the visit APC, but is considered part of

the cost of caring for the patient.

If a casting or strapping procedure is performed after a closed or

open reduction of a fracture, the casting and strapping are not

separately reportable but are considered incidental. National Correct

Coding Initiative Electronic Edits will reject the casting and

strapping codes if reported on the same date of service as the more

definitive fracture care services. Similarly, if a reduction of a

dislocation is performed, the casting and strapping are considered

incidental to that service and not separately reportable.

The immobilizer that is not customized (but instead is an off-the-

self item) is considered the same as the post-op shoe. Applying the

item is not separately reportable but the supply itself can be listed

separately. The application service can be considered in the level of

service EM facility charge.

A customized immobilizer that is fabricated and customized to a

specific patient can be charged as a service under the appropriate

physical or occupational therapy (PT, OT) code, 97504 (modifier GO or

GP) per each 15 minute unit, after a PT or OT evaluation has been

ordered and performed