Obtaining reimbursement for cast and splint supplies has always been a challenge in orthopedics, but HCFA (now CMS; see story on page 61) recently added complexity to the issue by introducing dozens of new temporary Q codes for casting and splint supplies. Although the HCPCS codes for cast and splint supplies are guidelines for Part B Medicare patients only, many private carriers also observe these guidelines.
What Has Changed?
Until now, coders have had few HCPCS codes to choose, primarily A4565 (slings), A4570 (splint), A4580 (cast supplies [e.g., plaster]) and A4590 (special casting material [e.g., fiberglass]). The challenge was not which code to choose but how to obtain fair reimbursement when payment policies varied from state to state and the durable medical equipment regional carrier (DMERC) was involved.
The recent HCFA program memorandum changes all that. Transmittal AB-01-60 introduces 51 new Q codes to use in place of A4570, A4580 and A4590. The codes cover splints and plaster and fiberglass casting materials, and they are subdivided by material, patient classification (pediatric or adult) and the type of cast applied (short arm, long leg, long arm, etc.). Although the memo is titled ""New Temporary 'Q' Codes for Splints and Casts Used for Fractures and Dislocations,"" the codes are for all procedures that require casts, splints and slings.
Old Versus New Systems for Coding
With the old HCPCS codes, orthopedic coders would indicate the CPT code for the procedure performed and choose the right supply code to describe the casting materials used, either A4580 or A4590 for plaster or fiberglass.
For example, for a 27-year-old patient with a fracture of the lower leg, the coder would select the appropriate CPT code, e.g., 29405 (application of short leg cast [below knee to toes]) and either A4580 or A4590 for supplies. The patient's age and the type of cast had no bearing on the supply code.
Under the new guidelines in the program memo, a specific supply code must be selected to indicate the type of cast, the patient's age and the material used. For the same patient whose broken leg is set with a short leg cast, the coder would now use either Q4037 (cast supplies, short leg cast, adult [11 years +], plaster), Q4038 (cast supplies, short leg cast, adult [11 years +], fiberglass), Q4039 (cast supplies, short leg cast, pediatric [0-10 years], plaster) or Q4040 (cast supplies, short leg cast, pediatric [0-10 years], fiberglass).
If the 27-year-old patient was fitted with a fiberglass short leg cast, the orthopedist would use Q4038, linked to 29405.
The following subsets of codes illustrate the specificity of the new coding system: Q4001-Q4002 -- adult body casts Q4003-Q4004 -- shoulder casts Q4005-Q4008 -- long arm casts Q4009-Q4012 -- short [...]