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  1. User id : 13062 Posted 3 years ago

    Does anyone know if I can bill Q4037 or A4580 with a -RT and -LT? I am billing for the casting of custom orthotics.

  2. SuperCoder Posted 3 years ago

    Yes, you could bill with Q code, but you need to be more careful while you are billing for cast supplies.

    If the cast application encounter involves a surgical procedure, you can bill Q4037 in addition to the cast application (such as 290xx series, Application cast; based on location, provided your orthopedist is not performing a surgical procedure on the same date of service. If your orthopedist did perform a surgical procedure, payers would bundle the cast application into the procedure, as well as injections. You can still, however, separately bill Q4037.
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    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, you would go for 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).

    The following subsets of codes illustrate the specificity of the coding system:
    Q4001-Q4002 – adult body casts
    Q4003-Q4004 – shoulder casts
    Q4005-Q4008 – long arm casts
    Q4009-Q4012 – short arm casts
    Q4013-Q4016 – gauntlet casts
    Q4017-Q4020 – long arm splints
    Q4021-Q4024 – short arm splints
    Q4025-Q4028 – hip spicas
    Q4029-Q4036 – long leg casts
    Q4037-Q4040 – short leg casts
    Q4041-Q4044 – long leg splints
    Q4045-Q4048 – short leg splints
    Q4049 – finger splints
    Q4050-Q4051 – unlisted and miscellaneous cast and splint supplies.
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    Pick cast supply code based on the patient’s age, type of cast/splint, and the type of cast material.
    Some workers’ compensation groups prefer A codes such as A4580 (Cast supplies [e.g., plaster]) or A4590 (Special casting material [e.g., fiberglass]). Most payers do not recognize this group of codes, however, it should verify properly before choosing an A code for casts.
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    Codes Q4001-Q4048 covers the gamut of cast supplies and application types. Each Q code fee includes the cast material, padding, and stockinette. Don’t forget about waterproof cast padding such as Procel/Gortex. Some health plans allow separate reimbursement for this material.
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    When you are reporting Q codes for your cast supplies include Q4050 (Cast supplies, for unlisted types and materials of casts), you should include a note in Box 19 of the supply and type of cast applied (such as “waterproof cast padding for short leg cast”), also include the supporting documentation of medical necessity to meet payer requirements.
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    Medicare no longer processes claims submitted with HCPCS codes A4580 and A4590. You should go Q codes for cast supplies. These Q codes are specific to the type of cast applied and the patient classification (pediatric versus adult). Some non-Medicare payers may now accept these codes, and you may want to poll your major payers on this issue.
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    Check with your local Medicare carrier to see if it has a local medical review policy (LMRP) on cast supplies. Several states do, and this allows for payment for cast supplies used when treating a fracture, but prohibits it at other times. If a cast is applied for any other reason, such as after an ankle fusion surgery, the cast supplies may not be reimbursed.
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    If you are experiencing denials from other carriers, you’ll need to do some research. Some payers do not cover cast supplies. If you are contracted with the payer, you can’t make the patient pay. If you are not contracted with the payer, tell your patients that cast supplies may not be a covered expense and that they may have to pay out-of-pocket. An advance beneficiary notice is not needed if the practice finds out from the local Medicare carrier that supplies are not covered for certain, specific circumstances

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  • Posted by 13062, 3 years ago. There are 2 posts. The latest reply is from .