EDITORIAL

An Editorial Note on Nomenclature:

Orthosis Versus Splint
Preface to the editorial: This note from
Jerry Coverdale, OT, CHT, reflects a
change in how we describe orthotic devices in the Journal of Hand Therapy.
Please note this change in the journals
Instructions to Authors.
As the 2011 American Society of
Hand Therapists (ASHT) president
and someone who is a devoted advocate for hand therapists, I would like
to briefly share with you the history
of the last 10 years where we have
battled to ensure that Occupational
and Physical Therapists meet the
qualifications to fabricate, dispense,
and be compensated for the orthoses
we dispense. I am happy to report
that this fight has resulted in victory
due to the dedication and support
from the:

 American Society of Hand

Therapists (ASHT)
 Hand Therapy Certification
Commission (HTCC)
 American Occupational Therapy
Association (AOTA)
 American Physical Therapy
Association (APTA)
 American Society for Surgery
of the Hand (ASSH)
 American Association for Hand
Surgery (AAHS)
 American Medical Association
(AMA)
Within ASHT, individuals such as
Ginger Clark, Chris Blake, Nancy
Cannon, Elizabeth deHerder, Keri
Landrieu, myself, and many others
too numerous to mention, have
dedicated extraordinary amounts
of time, energy, and expertise to
ensure our rights are protected.
This issue, in my opinion, has

Correspondence and reprint requests to

Jerry J. Coverdale, OT, CHTASHT
President, 4875 N Federal Hwy, Ft Lauderdale, FL 33308; e-mail: <jcover6248@
aol.com>.
doi:10.1016/j.jht.2011.10.002

unified a very diverse group of

hand therapist and professional associations in protecting our scope
of practice within the area of orthotics and prosthetics.
In these times of uncertainty with
health care reform, we often have to
monitor, interpret, and at times take
a stance on legislative and regulatory changes at the state and federal
levels. These changes may affect the
scope of practice and reimbursement of occupational therapists
and physical therapist that provide
hand therapy. Our right to dispense
and fabricate orthotics in the treatment of our hand-injured patients is
not an exception. In the past several
years, the qualifications of occupational and physical therapists to
dispense and fabricate these devices
have been questioned by the
Centers for Medicare and Medicaid
Services (CMS) and state legislatures.1 In 2000, Congress passed
legislation that required CMS to develop a regulation through a negotiated rulemaking process to restrict
payment for custom fabricated orthotics and all prosthetics to only
those that are provided by qualified
practitioners and qualified suppliers. OTs and PTs are currently
included as qualified practitioners
in the law. The CMS negotiated
rulemaking failed to reach consensus and CMS has not issued a regulation to implement this legislation
(Section 427 of BIPA) to date.
ASHT, working with AOTA and
APTA continued with advocacy
efforts with CMS to ensure that
OTs and PTs may continue to be
paid for a full range of orthotics, despite efforts by the orthotic and
prosthetic industry to limit payment.2 Because policymakers and
payers have questioned OT and PT
qualifications to dispense and fabricate orthoses, it is extremely important that we use the proper
language that has been adopted by
CMS. This is especially important

because many payers follow CMS

guidelines.
Although we have used the term
splint for many years, CMS does
not recognize these devices by that
name. They designate the term
Orthotic devices (orthoses) as defined in the 2008 DMEPOS Quality
Standards.
Orthotic Devices: Rigid and
semirigid devices used for the purpose of supporting a weak or deformed body member or restricting
or eliminating motion in a diseased
or injured part of the body.
CMS
also
uses
the
term
Orthoses in the level II Health
care Common Procedural Coding
System (HCPCS) when referring to
the L code definitions.3 A splint is
described using Current Procedural
Terminology (CPT) as casts and
strapping.4
Therefore, it is imperative that we
make a shift in the terminology that
we use in our

1.
2.
3.
4.

Documentation,
Patient education,
Student education,
Therapist continuing
education,
5. Publications,
6. Literature/research, and
7. Communication with physicians and payers.
So, what is the proper terminology?

* Orthosis is a noun and should

be used in place of splint.
* Orthoses is a plural noun and
should be used for multiple
splints.
* Fabricating an orthosis or
orthosis fabrication should be
used in place of the verb
splinting.
* Orthotic is an adjective and is
used to describe a noun associated with the science of orthotic
devices, orthotic treatment
JanuaryeMarch 2012

plan, orthotic intervention, or

orthotic coding.
Because it is our research that is the
foundation and strength of our beloved profession, I commend everyone who expends countless hours
constructing, undertaking, and publishing literature in the JHT. I, along
with the JHT editor Paul LaStayo,
implore each of you to make the
switch in terminologies that will
aide us in strengthening our qualifications to fabricate and dispense orthoses for our patients. I realize that

JOURNAL OF HAND THERAPY

the JHT publishes numerous international papers and this issue does not
affect their scope of practice or reimbursement. I can only ask for the support of the international authors by
incorporating the correct language
in their literature being published
within the JHT.
The battle is not over and I assure
you that with your help we will
continue to fight the good fight.
Jerry J. Coverdale, OT, CHT
ASHT President

REFERENCES
1. Center for Medicare and Medicade Services. DMEPOS Quality Standards October 2008, Schedule C, pp. 15e6.
Available at: http://www.cms.hhs.gov/
medicareprovidersupenroll/downloads/
dmeposaccreditationstandards.pdf.
2. American Occupational Therapy Association: State of Affairs Group, Bethesda, MD.
3. HCPCS Level II Professional. MAG
Mutual Healthcare Solutions, Inc:
Atlanta, GA: 2011, pp. 95e7.
4. CPT Professional Edition. American
Medical Association: Chicago, IL:
2011, pp. 143, 144.