Wiki Cast Removal and Cast Application on same day

[jhaleycoder]

Need some coding help!

I am trying to see if I can bill a cast removal and cast application on the same day using modifier -77 on the cast removal as a different physician put the cast on initially. CPT codes used 29705//77 and 29075. UHC has denied the cast removal as can't be billed on the same day as the application. Please let me know! Not sure if I should appeal!

Example: Patient fractures arm on vacation and is put in a long arm cast. She is told to follow-up care with a local orthopedic in 3 weeks. Patient follows-up with an orthopedic at home. Cast is removed by new orthopedic but fracture is still not healed, so a new cast application is done. Another 3 weeks in cast.

 

[MI_CODER]

This is a tricky case.

According to the Application and Strapping guidelines in the 2018 CPT book (pg 170), it states "Listed procedures include removal of cast or strapping."

Even though your provider is removing the cast placed by the other provider he can't bill for the removal because he also placed a new cast during the same encounter. According to the guidelines, this removal is included in the placement. However, my understanding is your provider could have billed for the removal if that was the only procedure being performed.