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Modifier Help - cast and reapplied

  1. Default Modifier Help - cast and reapplied
    Medical Coding Books
    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?

  2. #2
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    no, a removal of the cast is not reimburseable

  3. #3
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    pls look at -77
    Quote Originally Posted by Mohana Prasad View Post
    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?
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  4. #4
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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.
    Last edited by mbort; 08-01-2008 at 12:37 PM. Reason: typo

  5. #5
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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}
    Donna, CPC, CPC-H

  6. #6
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    Donna,

    For what scenario would you choose the -58 modifier for cast application?

  7. #7
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    I would use it on Dr. XYZ's cast application code. IF both providers were from the same practice/facility.
    Donna, CPC, CPC-H

  8. #8
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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

  9. #9
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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}
    Donna, CPC, CPC-H

  10. #10
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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.
    Last edited by mbort; 08-01-2008 at 02:53 PM.

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