Recently, a three-year-old presented to our office with a history of falling off a chair and injuring his right wrist. After carrying out a physical, the pediatrician orders an x-ray which shows a buckle fracture of the right wrist. For the time being, the doctor protects the injury with a forearm splint and refers the established patient to an orthopedic surgeon for restorative treatment. Here, can I code for the splinting?
Since the pediatrician provides only the initial splinting without restorative treatment, you can code for the forearm splinting with 29125 (Application of short arm splint [forearm to hand]; static). As an alternative, if the pediatrician carried out the definitive fracture care, including the pre- and post-operative fracture care, the global fracture code 25600, Closed treatment of distal radial fracture [example., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation) would include the initial cast or splint.
In both situations, the pediatrician can still code for the x-ray (73090, Radiologic examination; forearm, two views). Even though the splint is also a separately billable service, some plans may consider the forearm splint (A4590, Special casting material [for instance fiber glass] DME and not pay the physician unless he has obtained DME certification.
In order to report an E/M for the evaluation from the fall, the pediatrician would have to have performed and documented a medically necessary significant and separately identifiable E/M service above and beyond the minor E/M already included in 29125. You would use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the day of the procedure or other service) to the evaluation & management service that you report with 29125.
According to CPT, you can report further significant identifiable services carried out at the time of the cast/splint application. A fall from a chair may engage checking for possible head injury and any other wounds, and will most likely call for an expanded problem focused history and exam, which could support 99213-25.
For more specialty-specific articles to assist your pediatric coding and for other medical coding updates, sign up for a coding resource like Coding Institute.