Vera Posted Thu 03rd of January, 2013 22:39:04 PM
I am wondering if I can bill Medicare for a second cast in two days. The patient was put in a cast after surgery, and then the very next day came into our clinic, with a wet, broken cast (clearly did not follow any instructions) - and we had to remove the cast and put on a new one ... how would you bill this ? It was time consuming and clearly the patients own doing?
SuperCoder Answered Mon 07th of January, 2013 19:55:47 PM
The patient returns to the same physician for follow-up care, and the physician replaces the cast. The physician can report the code for the application of the cast and supplies. CPT allows separate coding and charging of any follow-up care related to the condition and devices used, including application of casts, splints, or strapping if definitive treatment has already been performed.
The same patient then returns to the same physician, who removes the cast. The physician may not report the removal of cast, because the removal by the same physician or a physician in the same physician group is included in the application code. The removal of cast codes may only be assigned when a different physician in a different physician group removes the cast.
The intent of the CPT casts/splints/strapping code series is the same for both physician and outpatient hospital reporting; however, carriers and fiscal intermediaries have established different guidelines for facilities and physicians. The following discussion outlines what is considered best practice guidelines for each setting.