Casting Conundrum: Correct Coding for Casts, Splints, and Strapping (2023)

by Tanai S. Nelson , CCS, CCS-P, and Christina Benjamin , MA, RHIA, CCS, CCS-P

Correctly coding casts, splints, and strapping can be confusing. Much of the confusion is related to what type of materials are classified as casts, splints, or strapping; whether the CPT application codes or the HCPCS level II codes should be assigned; and whether the work performed is included in E/M codes.

This article provides general guidance and suggested best practices for sorting out these issues.

Defining Treatment Modality

A cast is a “rigid dressing, molded to the body while pliable and hardening as it dries,” that provides firm support; it does not allow movement. 1 A splint is any stiff device attached to a limb in order to discourage movement. There are two types of splints: static or dynamic. 2 Static splints provide full immobilization, while dynamic splints allow some movement. 3

Strapping refers to the application of overlapping strips of adhesive plaster or tape to a body part to exert pressure and hold a structure in place. 4

Basic Rules

One of the first principles of coding casts, splints, and strapping is to understand when a separate code can be reported in relation to a restorative treatment or procedure code. Coders should ask themselves the following questions before reporting an initial casts/splints/strapping code:

  • Will any restorative treatment or procedure be performed or is one expected to be performed (e.g., surgical repair, closed or open reduction of a fracture, or joint dislocation)?
  • Will the same physician assume all subsequent fracture, dislocation, or injury care?

The answers will aid coders in deciding if casts/splints/strapping codes should be reported. Final code determination should be based on the specific rules in the general guidelines preceding the application of casts and strapping heading in the CPT book.

Examples of how these guidelines should be applied in facility and physician office settings are outlined below.

ED Visit

A patient is diagnosed with an ankle fracture in the emergency department. The physician applies a short leg cast and refers the patient to an orthopedist.

If the physician applies the cast, coders should report the code for the application of the cast. If the hospital staff applies the cast, the facility will report the same code. The facility should also charge for the supply, as appropriate.

Orthopedic Visit

The same patient presents to the orthopedist for definitive treatment. Closed reduction with manipulation is performed and a cast applied.

Coders should report the CPT code for closed treatment of the fracture only, because cast application is integral to any definitive fracture treatment. The physician may report supplies with the appropriate Q codes.

If the closed reduction had been performed in the emergency department, the facility would only assign codes for the treatment and the supply, if applicable, but not for the application of the cast.

If the same physician will not provide follow-up care, modifier 54 should be assigned to the CPT code, and the second physician who provides the follow-up care (involving more than just cast or splint removal or replacement) should assign the same code with modifier 55.

(Video) Coding Cast & X-ray Application During Post-op | Medical Coding Tips

The patient returns to the same physician for follow-up care, and the physician replaces the cast. The physician can report the code for the application of the cast and supplies. CPT allows separate coding and charging of any follow-up care related to the condition and devices used, including application of casts, splints, or strapping if definitive treatment has already been performed.

The same patient then returns to the same physician, who removes the cast. The physician may not report the removal of cast, because the removal by the same physician or a physician in the same physician group is included in the application code. The removal of cast codes may only be assigned when a different physician in a different physician group removes the cast.

The intent of the CPT casts/splints/strapping code series is the same for both physician and outpatient hospital reporting; however, carriers and fiscal intermediaries have established different guidelines for facilities and physicians. The following discussion outlines what is considered best practice guidelines for each setting.

Physician Office Reporting

In the physician office setting, the CPT application codes are assigned along with a code for the supplies and materials. The supplies and materials can be billed separately using CPT code 99070 or HCPCS Q codes. There are two separate Q codes for the material for casts or splints that are made of any type of material. The Q code for splints includes the material for strapping.

The most conservative position by a Medicare carrier on the issue of CPT application codes is that these codes should be assigned only if the cast or splint is fabricated or custom-made and prepared with the materials specified in the Q codes. Therefore, if the cast or splint is prefabricated, only the evaluation and management code is assigned with a supply code. The reasoning is that the CPT application codes represent the work and expertise required for applying a fabricated or custom-made device.

Suggested best practice in the absence of official guidance would be to assign the application code only when the device is fabricated or custom-made. Each office should verify the guidelines with its carrier.

Hospital Reporting

In the facility, the application code is not always assigned with the supply code and therefore can be more challenging. Facilities have more choices in the supply codes for these devices, including HCPCS L codes. The question arises as to when facilities would use the application codes in conjunction with the supply codes.

In the April 2009 OPPS update, CMS instructs hospitals to report only the HCPCS supply code if the code description refers to the inclusion of fitting and adjustment. The HCPCS code for the device already includes the services identified in the CPT application codes. Coders should keep in mind that all procedures reported in the hospital outpatient setting must be done under physician supervision per the 2009 OPPS final rule, regardless of which staff member applies the device.

As an example, coding L1800 and 29515 together is inappropriate because L1800 includes fitting and adjustment, which is equivalent to application of the device. In most cases, a prefabricated device is billed with an L code, which precludes the use of the CPT application codes. Several of the codes also refer to custom-made devices such as L3670–L3673, which also include the fitting and adjustment verbiage.

There are only a few HCPCS codes that do not include application. In these cases, the appropriate CPT level 1 code is assigned to represent the application of the device. For example, S codes refer to prefabricated splint devices, but they do not mention fitting and adjustment. If a payer accepts these codes, then the application for the device may be assigned from the CPT code set.

According to the AHA Coding Clinic for HCPCS , a facility may report a CPT code for application of prepackaged splints. Further clarification states that no specific CPT codes differentiate between immobilizing devices that require little or no technical expertise and splints that are fabricated or off the shelf. Prepackaged or prefabricated splints are coded the same as fabricated or custom-made splints. CPT codes for application of casts, splints, or strapping do not specify the type of device or material used or the work required for applying a prefabricated or custom-made splint. Note that this guidance is different from some payers' interpretation of the CPT codes for physician reporting.

Common Casting, Strapping, and Splinting Hospital Supply Codes

Commonly used casting, strapping, and splinting supplies with recommended code choices for use in a hospital setting are provided below. These recommendations are primarily based on AHA Coding Clinic for HCPCS.

Supply

Codes

(Video) Carbon shoes, Orthotics & Triathlon Injuries (Myths, misconceptions with Podiatrist Matt Fieldsend)

Cast-cast application

29049–29425

Splint-splint application

29105–29515

Air cast-supply

A4580 or L2132–L2136 alone

Buddy taping

Not coded

Clavicle strap-strapping

29240

Cast post-op shoe-supply

L3260

Cervical collar foam/stiff neck

Not coded

Durabracer/3Dwalker/equalizer boot-splint application

29505–29515

Cam walker-supply

L4360

Figure 8 thumb-splint application

29130

Jones dressing-splint application

29105–29515

Knee immobolizer-splint application

29505 or L1830

Shoulder immobilizer-splint application

29105 or L3670

Rib belt-supply

L0210; L0220

Sling-supply

A4565

Sling and swathe-strapping

29240 or L3969

Swede brace/splint-splint application

29105–29515 or L4370, L4380

Thumb spica-splint application

29130

Unna boot-strapping

29580

Denis-Browne splint strapping

29590

Miscellaneous Supplies

Per AHA Coding Clinic for HCPCS ace bandages and slings are often used with casts and splints and are not separately reportable. However, the supply may be billed separately. Without specific guidance, the best practice is to consider these supplies as part of the E/M service.

Some supplies such as splints and post-op shoes applied after surgery, used only to augment wound repair, are considered part of the operative procedure. Best practice guidance is to charge only the supply for these items. Otherwise, and in the absence of specific guidance, if the OCE edits allow billing for the application of splints with wound repair, then it is appropriate to assign these codes together.

Notes

    1. Dorland’s Illustrated Medical Dictionary, 31st edition. Philadelphia, PA: W.B. Saunders, 2007.

    2.American Medical Association. CPT Code Book. Chicago, IL: AMA, 2009.

    3.Ingenix. Coders’ Desk Reference for Procedures. Eden Prairie, MN: Ingenix, 2009.

    4. Dorland's Illustrated Medical Dictionary.

References

American Hospital Association. AHA Coding Clinic for HCPCS , first quarter (2007): 9

American Hospital Association. AHA Coding Clinic for HCPCS , second quarter (2002): 3.

American Medical Association. AMA CPT Assistant 19, no. 5 (May 2009): 8.

American Medical Association. AMA CPT Assistant 6 , no. 2. (Feb. 1996): 3–5.

Tanai S. Nelson (tanai.nelson@ahima.org) is a practice resources specialist for AHIMA, and Christina Benjamin (cmbenjamin@bellsouth.net) is an independent coding and education consultant.

Article citation:
Nelson, Tanai S; Benjamin, Christina. "Casting Conundrum: Correct Coding for Casts, Splints, and Strapping " Journal of AHIMA 80, no.7 (July 2009): 74-76.

Article citation:
Nelson, Tanai S; Benjamin, Christina. "Casting Conundrum: Correct Coding for Casts, Splints, and Strapping " Journal of AHIMA 80, no.7 (July 2009): 74-76.

FAQs

What is the CPT code for splint? ›

CPT® 29125, Under Body and Upper Extremity Application of Splints.

What is procedure code 29505? ›

The Current Procedural Terminology (CPT®) code 29505 as maintained by American Medical Association, is a medical procedural code under the range - Lower Extremity Application of Splints.

Can you bill for splint application? ›

For all payors, physicians may bill for strapping application only if it is documented in the chart that they personally applied it. For Medicare charts, physicians may bill for a splint application only if it is documented in the chart that they personally applied it.

What is considered strapping? ›

Strapping is used when the desired effect is to provide immobilization or restriction of movement. Strapping refers to the application of overlapping strips of tape or adhesive plaster to a body part to exert pressure on it and serve as a splint to hold a structure in place and reduce motion.

When can a coder assign an application of a cast or strapping code? ›

When can you use the Application of Cast & Strapping codes? When physician applies initial cast, strapping or splint for stabilization prior to definitive treatment by other provider, applies subsequent cast, strapping or splint, treats sprain and does not expect o provide any other type of restorative treatment.

Is an ace wrap considered strapping? ›

no, wrapping an Ace wrap on an ankle does not qualify for strapping. Its part of the E/M however depending on your contracts you may be able to use the 99070 for the supply of the ace.

What is the CPT code for the application of a short leg splint? ›

CPT® 29515, Under Lower Extremity Application of Splints. The Current Procedural Terminology (CPT®) code 29515 as maintained by American Medical Association, is a medical procedural code under the range - Lower Extremity Application of Splints.

What is the CPT code for Ortho glass splint? ›

CPT® Code 29125 in section: Application of short arm splint (forearm to hand)

What is procedure code 73610? ›

CPT® Code 73610 in section: Radiologic examination, ankle.

What is the CPT code 27792? ›

CPT® Code 27792 - Fracture and/or Dislocation Procedures on the Leg (Tibia and Fibula) and Ankle Joint - Codify by AAPC.

What is included in CPT 12001? ›

CPT 12001 – Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet). This code is used for the simplest type of superficial repair of a wound that does not exceed 2.5 cm in length.

Can you bill Office visit with cast application? ›

A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping. 4.

Is a splint considered an orthotic? ›

Orthosis is the proper term that applies to a custom-fabricated brace/splint. Medicare considers an orthosis a rigid or semi-rigid device that supports a weak or deformed body member, or restricts or eliminates motion in a diseased or injured part of the body.

Is splint included in reduction? ›

If you report closed reduction w/o manipulation:

Cast/splint/strapping is included. X-ray and supplies may be separately reported.

What is the code for strapping? ›

CPT
29200Strapping; thorax
29240Strapping; shoulder (eg, Velpeau)
29260Strapping; elbow or wrist
29520Strapping; hip
5 more rows

Does Medicare pay for strapping? ›

Medicare Benefits for Kinesio Tape

Kinesio tape is a considered a supply, and Medicare benefits are not typically granted for supplies unless they are deemed medically necessary. In that case, Medicare Part B does cover some supplies under durable medical equipment benefit.

Can you bill for a replacement cast? ›

Are cast re-applications billing during the global period? Yes! The first cast is inclusive to the global surgical CPT code, but re-applications are billable, assuming of course, that medical necessity is present.

What is the correct code for the application of a short arm cast quizlet? ›

What is the correct code for the application of a short arm cast? Rationale: In the CPT® Index, look for Cast/Type/Ambulatory/Short Arm. The code you are directed to use is 29075.

Can you code a splint with a laceration repair? ›

Splint and Suture

If the physician placed the splint you can code for both the splinting and laceration repair in additon to the E&M.

What is the CPT code for long arm splint? ›

HCPCS code Q4018 for Cast supplies, long arm splint, adult (11 years +), fiberglass as maintained by CMS falls under Cast and Splint Supplies .

How often should you replace strapping? ›

How long should I keep strapping tape on for? Strapping tape is effective for 3 days to 1 week following an application. Should you experience any irritation on your skin under the tape (like itching or burning) you must remove the tape immediately to avoid any further skin irritation.

What is orthopedic strapping? ›

This strapping is intended to minimize foot pronation, collapse, or flattening which causes over use and irritation to the muscle, tendons, and ligaments in the foot. Often, relief of pain with the strapping is a diagnostic indication for the need of functional orthotic devices.

Is Buddy taping considered fracture care? ›

Answer: If the physician provides restorative/definitive care for the patient's broken toe, the service could be fracture care. Often, buddy taping is the definitive treatment for broken toes/fingers.

What is the CPT code for application of a long leg cast? ›

CPT® Code 29345 in section: Application of long leg cast (thigh to toes)

What is a short arm cast? ›

The short arm cast is also known as the below-elbow cast. This is a frequently used circumferential immobilization cast of the forearm and wrist made of either synthetic material or plaster of Paris, used as a treatment for some local fractures and soft tissue injuries.

Is an ulnar gutter splint a short arm splint? ›

Any injuries to the fourth or fifth proximal phalanges, the metacarpals, the ulnar side of the wrist, or the distal ulna are amenable to an ulnar gutter splint, a specific type of short arm splint.

What is the CPT code for fiberglass cast? ›

HCPCS code Q4010 for Cast supplies, short arm cast, adult (11 years +), fiberglass as maintained by CMS falls under Cast and Splint Supplies .

Does CPT code 29125 need a modifier? ›

Per cci, 29125 is bundled to 20526[50] but a modifier is allowed.

Is an ortho glass splint prefabricated? ›

There are 2 types of traditional splinting material – plaster and fiberglass. Plaster allows for more malleability, whereas fiberglass is more lightweight and easier to apply. There are also prefabricated splints such as Ortho-Glass®.

What is procedure code 73080? ›

CPT® Code 73080 - Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities - Codify by AAPC.

What is procedure code 99283? ›

99283. Emergency department visit 99283 is used for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and. Medical decision making of moderate complexity.

What is procedure code 73562? ›

The Current Procedural Terminology (CPT®) code 73562 as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities.

What is the CPT code 27814? ›

27814 Open treatment of bimalleolar ankle fracture (e.g., lateral and medial malleoli, or. lateral and posterior malleoli, or medial and posterior malleoli), includes internal. fixation when performed.

What CPT code is 28505? ›

CPT® Code 28505 - Fracture and/or Dislocation Procedures on the Foot and Toes - Codify by AAPC.

What is included in CPT code 20680? ›

Code 20680 [Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)] describes a unit of service that is typically reported only once, provided the original injury is located at only one anatomic site, regardless of the number of screws, plates, or rods inserted, or the number of ...

Does CPT code 12001 need a modifier? ›

Under some circumstances highly complex procedures are carried out under the “surgical team” concept. Each participating physician would report the basic procedure with the addition of modifier -66.

What is included in CPT 13160? ›

Based on the situation, the surgery performed in the OR should be billed with CPT 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated).

Does CPT code 12002 need a modifier? ›

There's no NCCI edit listing E/M codes as incidental or mutually exclusive to 12002, but most payers require a 25 modifier on the E/M. Hope that helps!

What is the CPT code for Ortho glass splint? ›

CPT® Code 29125 in section: Application of short arm splint (forearm to hand)

What is the CPT code for long arm splint? ›

HCPCS code Q4018 for Cast supplies, long arm splint, adult (11 years +), fiberglass as maintained by CMS falls under Cast and Splint Supplies .

What is a splint in the human body? ›

A splint is a supportive device that protects a broken bone or injury. A splint keeps the injured part of your body still to help with pain and promote healing. Some splints are flexible and some are rigid. The type of splint you need will depend on the type of injury you have and the part of your body that is injured.

What is dental Code D4321? ›

D4321 provisional splinting – extracoronal

This is an interim stabilization of mobile teeth. A variety of methods and appliances may be employed for this purpose.

Is an ace wrap considered strapping? ›

no, wrapping an Ace wrap on an ankle does not qualify for strapping. Its part of the E/M however depending on your contracts you may be able to use the 99070 for the supply of the ace.

What is the CPT code for the application of a short leg splint? ›

CPT® 29515, Under Lower Extremity Application of Splints. The Current Procedural Terminology (CPT®) code 29515 as maintained by American Medical Association, is a medical procedural code under the range - Lower Extremity Application of Splints.

Does Medicare pay for cast supplies? ›

In the Medicare physician fee schedule beginning in 2001, the casting supplies were removed from the practice expenses for all HCPCS codes, including the CPT codes for fracture management and for casts and splints.

What is the CPT code for application of a long leg cast? ›

CPT® Code 29345 in section: Application of long leg cast (thigh to toes)

Is a splint considered an orthotic? ›

Orthosis is the proper term that applies to a custom-fabricated brace/splint. Medicare considers an orthosis a rigid or semi-rigid device that supports a weak or deformed body member, or restricts or eliminates motion in a diseased or injured part of the body.

Can you bill Office visit with cast application? ›

A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping. 4.

What are the 3 types of splints? ›

Splint Types
  • Long leg posterior splint.
  • Stirrup splint.
  • Posterior ankle splint.
16 Jun 2021

What are the 2 types of splints? ›

Rigid Splint: Any rigid object, such as wood or plastic boards, broomstick, book or a rolled-out newspapers, which can be used to splint a fractured arm or leg. Flexible Splint: Any flexible object, like a pillow or a bed sheet with several folds.

What are four different types of splints? ›

Types
  • Ankle stirrup – Used for the ankles.
  • Finger splints – Used for the fingers. ...
  • Nasal splint.
  • Posterior lower leg.
  • Posterior full leg.
  • Posterior elbow.
  • Sugar tong – Used for the forearm or wrist. ...
  • Thumb spica – Used for the thumb.

What is dental Code D0363? ›

ADA/Dental: D0363 ("Three-dimensional image reconstruction using existing data, includes multiple images.")

What is dental Code D0230? ›

D0230. Intraoral periapical – each additional radiographic. image.

What is dental Code D7880? ›

The description for code D7880 is that of an "occlusal orthotic device." The CDT specifically states that the code includes splints utilized for the treatment of temporomandibular joint dysfunction.

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