Musculoskeletal System Fractures, Dislocations, and Splinting
Musculoskeletal procedure coding separates fracture care from splinting and from reductions. Fracture treatment includes closed treatment without manipulation, closed treatment with manipulation, and open treatment. The choice depends on whether the provider manipulated the fracture and whether surgery was performed. A key concept is the global fracture care package: when a provider performs definitive fracture treatment, the code includes the initial application of the cast or splint and follow-up care during the global period.
Splinting and strapping codes are reported when the provider applies a splint without providing definitive fracture care, or when the splint is the only service. If the provider does definitive fracture treatment, do not separately bill the initial cast/splint application - it is bundled.
Dislocations are coded by joint and whether reduction was performed, with or without anesthesia. Traps: billing both a fracture treatment code and a separate splint application on the same date when the splint is part of the fracture package; reporting a reduction when the documentation shows only evaluation; and confusing strapping (soft tissue) with splinting (rigid immobilization).
Rule of thumb: ask whether the provider assumed definitive fracture care. If yes, report the fracture treatment code and bundle the initial immobilization. If the provider only immobilized without definitive treatment, report the splint/strapping code.