Modifier Help - cast and reapplied

Mohana Prasad

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Patient presents to office with cast applied earlier by a different physician. Dr. XYZ removed the cast and reapplied a new cast that was appropriate.

What modifier do we use so that he can be paid for the removal?
 

mbort

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the -77 would only be applicable if the services were provided by a provider outside the same practice and on the same DOS. This would be applied to the cast application code. There is still no reimbursement for the removal of the cast.
 
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dmaec

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modifier .58 on the cast application code IF it's from a provider within the same facility/practice as the original cast application. (cast removal is not billable)

{that's my opinion/advice on the posted matter}
 

mbort

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Since there are no global days for a cast application, I can not think of a scenario in which the -58 modifier would apply for cast application.

If two exact same cast applications (ie short arm) are done on the same DOS, the modifier 76 (same practice) or 77 (from another practice) would be applicable.

I suppose if the patient had a cast put on early in the morning and then told to come back for a cast change in the afternoon (cant even imagine that happenening although not impossible) ..that could be considered staged/related, but I still feel that the 76/77 would be more appropriate as a repeat procedure, same day.

If they were done on seperate days, no modifier would be indicated.

just my thought process :rolleyes:
 

dmaec

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well, we can only comment on what is posted. Often that creates differences in opinions. I can never know so much that I can't learn from someone else though! That's what I enjoy the most about this forum. Anyway -
From what was posted, it appears that another provider placed the initial cast - that being said - more likely than not they charged initial fracture treatment which does have global days. If the providers were in the same practice, I would append modifier .58 to the cast application code for Dr. XYZ - I don't see it as a "repeat procedure" because apparently Dr. XYZ placed a more appropriate cast on the patient. I see it as "related". That's my thought process on what was written.
However, modifier .76 is a good modifier also. If the provider is not at the same practice, I would then use modifier .77
Our claims have been denied when re-casted during the global period without the modifier .58 on them.
{that's my opinion/advice on the posted matter}
 

mbort

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gotcha..I didnt see in any of the previous posts that a fracture was mentioned thats why I was curious.

If there were a fracture code previously billed, then I could see the 58 being justified for the 1st cast.
 
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APRILT558

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hi i also have a question on modifiers. i work for an outpatient facility center and just came across a case where our physician performed removal off a foreign body from the patients nostril. the code i chose to bill was 30300 which states removal foreign body, intranasal: office type procedure so since we are an outpatient facility i was going if there is a modifier i could use to bill this? he was originally doing an adenoidectomy and bilateral tube placement when we found the foreign body and decided to remove it. if anyone could give me any information on this i would appreciate it!!
 
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