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HELP -Post Op Casting denials....

  1. Question HELP -Post Op Casting denials....
    Medical Coding Books
    Our doc does total ankles... Post op there is a cast removal and another application - that is included in global fee ???

    Pt had wound healing issues... so had to come in 2 weeks later for ANOTHER removal of cast (29705 & wound exam which required special medical honey application A6250) to wound AND another cast application (29405). Same procedure done another 2 weeks later. Diag Codes: aftercare (V54.81) and non healing wound (998.83)

    Our claims are being denied after the 1st post op visit for everything ! I didn't use 58 modifier... is THAT the problem or am I NOT to bill for anything ? B/c of the wound healing - this case requires continual casting, etc.. that I explained above .

  2. #2
    You definitely need to apply modifier 58 for casts/splints applied to the surgial site during the postoperative period. Your diagnosis codes look good.
    Many times supply codes beginning with an A are not covered ie the honey ointment, but the cast application and cast supply materials (fiberglass/plaster) should be paid

  3. #3
    I forgot to mention cast removals. The removal of a cast 29705 can only be billed if a different entity applied the cast initially. The CPT bok states , "Codes for cast removal should be employed only for casts applied by another individual." However this individual would have to work for a different business with a different tax ID, an outside provider.
    However, if your provider is "applying" postop casts/splints then those can be billed with modifier 58

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