# Help, My cast is too tight!



## heycodinglady (Oct 1, 2008)

New to Orthopedic coding here.  Patient returns within week of having short arm cast applied.  Patient having pain in arm.  Doc removes cast, xrays arm and reapplies cast.  Doc wants to bill office visit, cast removal, xray and reapplication of cast.  I don't think he can do that.  HELP!


----------



## dmaec (Oct 1, 2008)

if your doc placed the cast the first time (initial fracture treatment) - he cannot charge an E/M (patient within global) - or cast removal (these codes are used only for casts applied by another physician) -  

he can however charge a cast application code & Qcode supply for the re-casting.  Might need a modifier (.58) on the procedure - some insurances want it others don't - at my old facility we had to use it when we re-casted/splint within global - but here at the new facility, apparently their carriers don't want/request it.

again, this is based on the fact that your doc provided the initial fracture treatment.  

_{that's my opinion on the posted matter}_


----------



## kasmithortho (Oct 1, 2008)

*cast application*

I agree with the charge for cast application and supply code, but don't forget to charge for the x-ray as appropriate- global, modifier 26 or TC!

Karen S.


----------

