Are the cast room personal credentialed? Did they bill under their number or the physicianâ€™s name was sent on the claim?
Letâ€™s say they submit charges under the physicianâ€™s name. Did your physician bill for a fracture care?
If the physician billed for a fracture care then cast application shouldnâ€™t be billed on that day, it is bundled with the fracture care. However you can bill for the cast supplies. E/M service needs to be submitted with 57 modifier in this case.
If the physician did not bill for a fracture care, then his/her E/M should be submitted with 25 modifier if the cast was applied on the same day.
If cast application wasnâ€™t submitted under the physicianâ€™s name, but cast room personal has the same specialty number then E/M needs 25 modifier.
At my previous job we had FP doctors writing orders for a cast application and cast room techs applying cast. Since cast room techs services were under Ortho department, our FP doctors didnâ€™t need to add 25 modifier to their E/M.
Sofia, MS, CPC
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join