Global package for fracture care/CMS

maddismom

Guru
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Hi:

I have found some ortho sites that pretty much confirmed we could bill casting/splinting during a global for an ORIF, but we really want to make sure CMS specificially agrees. This is the scenario that was billed by the coder:

8/22 13132-wound repair hands (pd)
8/23 26735-58-ORIF (pd)
76000 fluoroscopy (pd)
29125-59 short arm splint (should this have been billed?) (pd)
9/1 Q4009-plaster cast (pd)
29075-short arm cast (not paid)
9/6 Q4010-fiberglass cast (pd)
29075-short arm cast (not paid)
9/20 Q4049-finger splint (pd)
29130-finger splint (not paid)

Does anyone have anything appropriate from CMS that says okay to bill for these last three procedures? And would mod 58 be appropriate?
Thanks!
 

tbauknight

Contributor
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Chapin, SC
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I know that you can code from series 29000-29750 if complications occur with the first cast or subsequent replacement is necessary. Also supplies are not included in the global period and should be reported separately. I would use the modifier 58 if you try to appeal.

Tammy B.
 

OliveJ

Contributor
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You need to append the 58 modifier to the subsequent casts/splints on order for CMS to pay. They do follow CPT and pay these separately in the global period. Not sure what supports the 59 modifier on the 8/23, but if it is for same extremity it should not have been billed.
 

maddismom

Guru
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You need to append the 58 modifier to the subsequent casts/splints on order for CMS to pay. They do follow CPT and pay these separately in the global period. Not sure what supports the 59 modifier on the 8/23, but if it is for same extremity it should not have been billed.
Thank you! I agree with the mod 59 call on the 8/23 surgery and am glad I wasn't the coder. ;) Will process a refund request for that one and add mod 58 to the others. Really appreciate your help!
 

armen

Guest
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Atlanta
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Thank you! I agree with the mod 59 call on the 8/23 surgery and am glad I wasn't the coder. ;) Will process a refund request for that one and add mod 58 to the others. Really appreciate your help!
Just use 58 and should have no problems. thats how we bill and never had problems with this.
 
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