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Cast re-applications

  1. #1
    Location
    North Carolina
    Posts
    3,126
    Default Cast re-applications
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    We have received some denials pertaining to our cast re-applications. These denials are coming from NC BCBS State Plan. They are bundling them into the global period. We have not had any problems with the other BCBS plans. I have made an inquiry to medical review and hope to receive an answer soon. In the meantime, has anyone else experienced this issue? We are not trying to bill an office visit in addition to the re-application and the fracture care care was performed on a previous date. We are using modifier 58, also. Someone has eluded that there are different guidelines for the State Plan. Does anyone know what these might be?

    Thoughts?

  2. #2
    Default
    What code is being denied? The supply code or the casting code? I know that state/medicaid plans want the Q codes instead of the A codes for the casting supplies. Is it that?

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    You shouldn't need modifier -58 with the casting codes by their definition. You just can't code the casting at the time of the fracture care itself.

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Although this may be politically correct, modifier 58 becomes carrier specific (at least for our area). See page 11~

    http://www.medicarenhic.com/provider...rgeryguide.pdf

    Regarding the State Plan, I have been notified by the medical review coordinator that the State Plan does bundle cast re-applications into the surgical procedure; unlike the other plans.

    Thanks for your input.
    Last edited by RebeccaWoodward*; 03-18-2008 at 06:00 PM. Reason: spelling

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Very interesting. Thank you for that information!

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