Orthopedic Coding Alert

Suppose a practitioner in your office applies the cast to a patient's fractured limb. You report the CPT code, and you-re all set, right? Not so fast. You-ll be writing off significant reimbursement if you aren't also reporting the appropriate supply code.

Depending on payer preference, choose the supply code from HCPCS- more general "A" section or more specific "Q" section. For a plaster cast, some possible codes include A4580 (Cast supplies [e.g., plaster]) and Q4005 (Cast supplies, long arm cast, adult [11 years +], plaster). For fiberglass, you might report A4590 (Special casting material [e.g., fiberglass]) or Q4006 (Cast supplies, long arm cast, adult [11 years +], fiberglass), among other codes.

No code exists for a combination plaster and fiberglass cast. If your physician applies such a cast, you should use Q4050 (Cast supplies, for unlisted types and materials of casts) or revert to CPT's miscellaneous supply code 99070 (Supplies and materials, provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).

Problem: Some practices balk at reporting the Q codes because they fear they-ll face a long road of denials and appeals with Medicare carriers, but seasoned coders recommend reporting these codes.

"I bill the casting codes and appropriate Q code and have no problem with reimbursement from Medicare," says Craig Groman of the Orthopedic Medical Center in Reseda, Calif.

If you-re reporting Q4050-Q4051 (Unlisted/miscellaneous cast/splint supplies), "some carriers require a description on the claim," Groman says. "We have found that without an ABN (advance beneficiary notice) signed from the patient, then that part of the casting material/supply that is denied by Medicare is not collectible from the secondary insurance or the patient."

What to do: Have the patient sign an ABN, and then append modifier GA (Waiver of liability statement on file) to your claim when billing Medicare, Groman says.

Be careful: You shouldn't report casting or strapping codes on an initial visit when you-re already reporting fracture care, says Kara Hawes, CPC-A, coder with Central States Orthopedic Specialists in Tulsa, Okla. "But we always bill our Q codes for supplies, always bill x-rays and always bill for Q4050 if the physician has indicated this supply was used," she says.

Remember: If you write off the cast supplies, you could be forfeiting approximately $50 per claim, depending on the supply used, so always report these codes when applicable.