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Short description: Sprain of wrist NOS. ICD-9-CM 842.00 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 842.00 should only be used for claims with a date of service on or before September 30, 2015. You are viewing the 2014 version of ICD-9-CM 842.00.
We had a patient who came in with a wrist injury. The final diagnosis was a sprained wrist. We applied a cock-up splint (HCPCS code L3908) with an Ace bandage. Can we bill out a strapping code and a splint application code together?
Ligaments form the connections between the different bones in the wrist (Figure 1). Ligament sprains range from mild stretches to partial tears. There are many ligaments in the wrist that can be sprained.
A sprained wrist is usually caused by a fall or sudden twisting motion. The wrist is usually bent backwards or into an abnormal position. A sprained wrist is often swollen and painful, especially with motion. There may be bruising. Pain and swelling can develop over several days and may last anywhere from a few days to six weeks.
If an elastic bandage was used to secure the splint, you would bill a HCPCS code from range A6448-A6450, depending on the size of the bandage. For example, if a short arm splint was made in the clinic from fiberglass materials for an 8-year-old, you would use HCPCS code Q4024, “Cast supplies, short arm splint, pediatric (0-10 years), fiberglass.”.
If the same splint was made for a 25-year-old, you would use code Q4022, “Cast supplies, short arm splint, adult (11 years +), fiberglass.”. In both cases, you would also assign CPT code 29125, “Application of short arm splint (forearm to hand); static” because the codes for application and strapping are not age-dependent. Q.
According to HCPCS, L3908 is defined as “Wrist-hand orthotic (WHO), wrist extension control cock-up, nonmolded, prefabricated, includes fitting and adjustment.”. Therefore, billing a splint application code along with this code would not be appropriate because the fitting and adjustment is included with the code.
A. CPT suggests that only the physician who provides the “restorative treatment” should code and bill for the fracture care.
CPT code 99051, “Service (s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service” is another code that could be billed to insurance plans, with the exception of Medicare. Evening hours are generally considered to start at 5 p.m.
The wrist, or carpus, contains eight carpal bones. There are three bones in the proximal row (scaphoid, lunate, and triquetrum) and five bones in the distal row (trapezium, trapezoid, capitate, hamate, and pisiform). The trapezium is also known as the greater multangular, the trapezoid as the lesser multangular, and the scaphoid as the navicular bone.#N#In ICD-10-CM, most wrist conditions coded from chapter 13 (M codes) have a “3” in the fifth position of the code such as M19.031 Primary osteoarthritis, right wrist. Common conditions of the wrist and distal radius from chapters 13 and 19 (M and S codes) are:
A wrist defect often requiring surgical intervention is scapholunate advanced collapse (SLAC.) SLAC is a condition of progressive instability that causes advanced radiocarpal and midcarpal osteoarthritis. SLAC describes a specific pattern of progressive subluxation with loss of articulation between the scaphoid and lunate bones. SLAC usually results from trauma to the wrist, but may be caused by a degenerative process such as calcinosis or as a sequela of a prior injury. SLAC is estimated to account for more than half of all non-traumatic wrist osteoarthritis cases.#N#Signs and symptoms of SLAC include:
De Quervain’s disease (radial styloid tenosynovitis) is an inflammation of the first dorsal extensor compartment; this is entrapment tendinitis causing tendon thickening, which leads to restricted motion and a grinding sensation with tendon movement (crepitus).
The wrist is classified as an “intermediate” joint, but consists of many intricate structures and bones. Accurate coding of wrist diagnoses, services, and procedures requires a solid working knowledge of wrist, hand, and distal forearm anatomy.
Sprained Wrist. A sprain is a partial injury to a ligament. Ligaments form the connections between the different bones in the wrist (Figure 1). Ligament sprains range from mild stretches to partial tears. There are many ligaments in the wrist that can be sprained.
There may be bruising. Pain and swelling can develop over several days and may last anywhere from a few days to six weeks.
There are many ligaments in the wrist that can be sprained. Two of the common ones are the scapholunate ligament, in the middle of the wrist between the scaphoid and lunate bones (Figure 2), and the TFCC (triangular fibrocartilage complex) on the outside of the wrist. Sometimes, a sprained wrist can pull off a tiny piece of bone.
Treatment typically involves resting the injured wrist and wearing a splint as needed until symptoms improve, which may take up to 6 weeks. Prescription pain medications are not usually recommended. If symptoms do not improve after a reasonable period of time, additional imaging may be ordered to look for a more serious injury.
Sometimes, a small piece of bone can be pulled off one of the wrist bones, called an avulsion. These small fractures frequently do not require surgery and may heal on their own.
X-rays are often taken. The purpose of the exam and x-rays is to make sure there are no broken bones, dislocated joints, or signs of a full ligament tear (Figure 3).