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Need help coding this - A cast was applied by one

  1. #1
    Default Need help coding this - A cast was applied by one
    Medical Coding Books
    A cast was applied by one of the physicians in our practice 8 weeks ago. The code used for the fx care was 27752, Clo tx tibial shaft fx.

    The patient is now returning and seeing a different physician in our practice for examination of the fracture. This physician, removed the cast, examined the fx under anesthesia and reapplied the cast.

    What code would be used for the billing of this procedure, since this wasn't the physician who initially applied the cast and treated the fracture?

    Any help would be greatly appreciated!

  2. #2
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    This service has a 90 day global period, therefore if the 2nd visit was provided by a physician in the same group and same speciality as the first provider, it is included in the global of the initial service.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  3. #3
    Default
    For some reason I thought it was billable if another physician reapplied the cast (didn't matter whether the doc was in the same practice or not).

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    you can code out the cast application - yes - that's billable - recasting is billable within the global -some carriers require a modifier .58 on the application code (but not all carriers)
    Donna, CPC, CPC-H

  5. #5
    Default coding
    I agree with Claudia, it's in the global and the physician is in the same group. Should be covered in the global package.

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I agree that it has a 90 day global and "normal" follow up within your group of physicians is "not billable", however:
    When the sole reason for the follow up visit is to replace the previously applied cast, splint, or strap, the physician may bill either an E&M code or a casting, splinting, or strapping code.
    The allowance for application of a cast, splint or strapping includes removal or repair by the same physician or other physician in the same group. Billing for cast removal or repair (29700-29750) should be employed only for casts applied by another physician group.

    so that being said - the recasting is billable, even within same group - however if it was "just a removal" or a repair - it would not be billable within the same group - ONLY if the cast was applied by another physician group.

    again, you might need the modifier .58 on it (at the other facility I worked at we had to use the .58 on the application code for recast if it was within the global)

    https://www.noridianmedicare.com/sha..._Treatment.htm
    Donna, CPC, CPC-H

  7. #7
    Default
    Thank you so much for all of your help, fellow coders.

    I have a little bit more of info. I went back to my physician and explained all that was said to me. And he doesn't understand why he wouldn't be able to code and bill for the work he did in addition to the reapplication of the cast. He explained to me he had to take the patient back to the OR and administer anesthesia. He says that this fracture is pretty rare and that he doesn't consider the work he performed as being "part of a routine checkup".

    Would this change anything?

    Thank you so much once again!!!

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
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    JoGelica,

    Can you post the scrubbed version of his operative report? If he took this patient back to an actual OR there may be something to capture.

    (keeping my fingers crossed that his documentation is IMMACULATE!!)

    Mary

  9. #9
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    you simply need to use modifier on his procedures... he is correct, this is above and beyond "normal" global follow-up - AND with a RETURN to OR, even Medicare allows for billing and coding of the procedures within a global perios when it's a return to OR.
    your provider is correct, he should be able to charge for his services, even though it's within the global period and especially since it was a return to OR. you will need to use the appropriate modifiers on the procedure codes.
    If I was coding this visit, I would certainly code/modifier and bill these services out.

    that is of course as Mary points out - IF it's an actual return to OR ... ! good point Mary

    {that's my opinion}}
    Last edited by dmaec; 10-17-2008 at 04:15 PM. Reason: actual return to OR
    Donna, CPC, CPC-H

  10. #10
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    With the additional details about going back to the OR, I agree. This is not routine follow up care. You did mention anesthesia in your original post. I should have asked for more details. So in the end, the return to the OR and documentation will support your coding of the 2nd service.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

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