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Orthopedic Coding Alert

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Practices Could Lose $1,000 Per Week Under New Rule

CMS wants to stop paying separately for casting supplies

If your office provides a lot of casts or splints, you could be casting away money next year.

CMS wants to stop paying separately for casting and splint supplies (Q4001-Q4051) in 2006, according to the Physician Fee Schedule proposed rule. Instead, CMS will make the supplies part of the practice expense RVUs for a laundry list of surgical codes. Payment Will Hinge on RVU Changes Provider perspective: The change will have minimal impact if CMS increases the RVUs for the surgical codes to accommodate the cost of the casting and splint supplies, says Wendy Snyder, a coder with Orthopedic Associates in Concord, Ohio.
But if CMS fails to account for the true cost of the casting and splint supplies, it could mean a -big hit.-

Already, experts are warning that a surgical practice that applies 10 casts per week will lose $1,000 per week.

CMS reasoning: The agency was concerned that it had inadvertently prohibited physicians from billing for casting or splint supplies -incident-to- physician services instead of when they-re used for reduction of a fracture or dislocation. Practices Hope for RVU Increases Resource: CMS encourages medical societies to review the practice expense inputs it is using to include costs for casting and splint supplies. The data is available at under -supporting documents.-

CMS is asking for information about the amount of casting supplies needed for 10-day and 90-day global periods, since patients may not need a cast change at every follow-up visit.

Offices are going to lose a dramatic amount of money if CMS doesn't increase the RVUs for the surgical codes enough to compensate for the supply cost loss, predicts coder Mary Brown with OrthoWest PC in Omaha, Neb. -We don't get enough to cover our expenses with the Q codes as it is,- she says. Expect an Increase in Fracture Care Charges Billing options: Orthopedic offices now have a choice between billing global fracture care and billing separately for each visit on an itemized basis. Often, the difference between the two methods isn't dramatic, experts say.
But if this change goes through, practices will be much more likely to bill for fracture care on an itemized basis, including separate E/M services, Brown says.

CMS included casting and splint supplies in the surgical codes until 2000, but the agency removed them because practices couldn't afford the supplies, Brown says. Now, if a practice has a patient who requires more than the average number of casts, there will be no way to avoid losing money.

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