Provider Appeals Department
City, State, ZIP Code
Re: Claim adjudication, bundling of splints (CPT codes 29105 - 29130 and 29505 -29515) with ED E&M services (CPT codes 99281-99285)
|Health Plan ID Number:||Group Number:|
|Insured/Plan Member:||Patient Name:|
|Claim Number:||Claim Date:|
The following information is being provided to clarify our use of Emergency Department Evaluation and Management Services (CPT codes 99281 - 99285) with splint application (CPT codes 29105 - 29130 and 29505 - 29515).
CPT® is the designated code set determined by HIPAA. CPT® states "Any specifically identifiable procedure (i.e., identified with a specific CPT code) performed on or subsequent to the date of initial or subsequent E/M services should be reported separately. Accordingly, when splint application is provided in addition to an ED E&M service, splints (CPT codes 29105 - 29130 and 29505 - 29515) are to be billed and reimbursed separately from the ED E&M Service (CPT codes 99281 - 99285). The performance of the splint application and ED E&M service are clearly documented in the patient chart and both should be recognized by [health plan] and eligible for payment.
Based on the circumstances of this case, we request that the splint application service be considered for separate reimbursement and not bundled under payment for the ED E&M service.
Please forward this information to your medical review staff to prevent this error from becoming an ongoing problem.
Thank you for your consideration. Please contact [staff name] at [telephone number] in our office should you have any questions regarding this claim.