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Orthopedic Coding Alert

READER QUESTIONS:

Don't Count on Casting Supply Reimbursement

Question: When can we bill for cast supplies? Can we bill "Q" codes with initial fracture care codes and cast application codes?

New York Subscriber Answer: You can report cast supply codes anytime the physician applies a cast or splint. You should report a HCPCS code from the "A" or "Q" series, or CPT code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) to reflect the appropriate casting material.

For example, suppose your surgeon applies a fiberglass cast to a 27-year-old patient with a lower leg fracture. You should report the appropriate fracture care or casting code, along with Q4038 (Cast supplies, short leg cast, adult [11 years +], fiberglass).

Reimbursement for cast supplies depends on carrier guidelines. Many payers will only reimburse for these supplies in certain circumstances, whereas other insurers may not reimburse you at all. Check with your insurer for specific payment guidelines.


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