Diane Posted Thu 18th of June, 2015 15:59:52 PM
I received a denial from an insurance company for a cast application with a 58 modifier. I appealed this decision and it was again denied saying that the charge was part of the global surgical package. I have never received a denial for this reason in the past and I thought I would check to see what information you have on billing for this service postoperatively. Thank you.
SuperCoder Answered Fri 19th of June, 2015 00:51:43 AM
Application of cast or re-application of cast is always included in the global period of the procedure. But if its a replacement due to wear and tear on the material.
The key is that if a cast change is made during the global period, a modifier, most likely -79 (unrelated procedure or service by the same physician during the postoperative period) must be used and a diagnosis code should support the need for a new cast. For example, 707.0 (decubitus ulcer; plaster ulcer) details a condition that requires a new cast application.