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o/v and casting

  1. #1
    Default o/v and casting
    Medical Coding Books
    I have a situation that I would like some help with. Lets say a clinic is self supporting, I mean it has its own radiology and casting departments. Patient A comes to the office and sees the doctor for a sore wrist. The doctor determines this patient has a distal radius fx and writes an order to have them placed in a short arm cast. When I code for the office visit lets say I use 99213. Will I need to append a modifier 25 to the office visit? The casting dept is billed out with the same tax id. The doctor only wrote the order for the cast and did not do any casting themselves.


  2. #2
    Are the cast room personal credentialed? Did they bill under their number or the physician's name was sent on the claim?
    Let's say they submit charges under the physician's name. Did your physician bill for a fracture care?
    If the physician billed for a fracture care then cast application shouldn'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 wasn't submitted under the physician'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 didn't need to add 25 modifier to their E/M.
    Make sense?

    Sofia, MS, CPC

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