# Need help coding this - A cast was applied by one



## JOGelico (Oct 17, 2008)

A cast was applied by one of the physicians in our practice 8 weeks ago. The code used for the fx care was 27752, Clo tx tibial shaft fx. 

The patient is now returning and seeing a different physician in our practice for examination of the fracture. This physician, removed the cast, examined the fx under anesthesia and reapplied the cast. 

What code would be used for the billing of this procedure, since this wasn't the physician who initially applied the cast and treated the fracture?

Any help would be greatly appreciated!


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## Claudia Yoakum-Watson (Oct 17, 2008)

This service has a 90 day global period, therefore if the 2nd visit was provided by a physician in the same group and same speciality as the first provider, it is included in the global of the initial service.


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## JOGelico (Oct 17, 2008)

For some reason I thought it was billable if another physician reapplied the cast (didn't matter whether the doc was in the same practice or not).


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## dmaec (Oct 17, 2008)

you can code out the cast application - yes - that's billable - recasting is billable within the global -some carriers require a modifier .58 on the application code (but not all carriers)


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## Anna Weaver (Oct 17, 2008)

*coding*

I agree with Claudia, it's in the global and the physician is in the same group. Should be covered in the global package.


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## dmaec (Oct 17, 2008)

I agree that it has a 90 day global and "normal" follow up within your group of physicians is "not billable", however:
When the sole reason for the follow up visit is to replace the previously applied cast, splint, or strap, the physician may bill either an E&M code or a casting, splinting, or strapping code.  
The allowance for application of a cast, splint or strapping includes removal or repair by the same physician or other physician in the same group. Billing for cast removal or repair (29700-29750) should be employed only for casts applied by another physician group. 

so that being said - the recasting is billable, even within same group - however if it was "just a removal" or a repair - it would not be billable within the same group - ONLY if the cast was applied by another physician group.

again, you might need the modifier .58 on it (at the other facility I worked at we had to use the .58 on the application code for recast if it was within the global)

https://www.noridianmedicare.com/sh...g_for_Definitive_or_Restorative_Treatment.htm


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## JOGelico (Oct 17, 2008)

Thank you so much for all of your help, fellow coders.

I have a little bit more of info. I went back to my physician and explained all that was said to me. And he doesn't understand why he wouldn't be able to code and bill for the work he did in addition to the reapplication of the cast. He explained to me he had to take the patient back to the OR and administer anesthesia. He says that this fracture is pretty rare and that he doesn't consider the work he performed as being "part of a routine checkup". 

Would this change anything?

Thank you so much once again!!!


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## mbort (Oct 17, 2008)

JoGelica,

Can you post the scrubbed version of his operative report?  If he took this patient back to an actual OR there may be something to capture.

(keeping my fingers crossed that his documentation is IMMACULATE!!)

Mary


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## dmaec (Oct 17, 2008)

you simply need to use modifier on his procedures... he is correct, this is above and beyond "normal" global follow-up - AND with a RETURN to OR, even Medicare allows for billing and coding of the procedures within a global perios when it's a return to OR.  
your provider is correct, he should be able to charge for his services, even though it's within the global period and especially since it was a return to OR.  you will need to use the appropriate modifiers on the procedure codes.
If I was coding this visit, I would certainly code/modifier and bill these services out.

that is of course as Mary points out - IF it's an actual return to OR ... ! good point Mary

_{that's my opinion}}_


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## Claudia Yoakum-Watson (Oct 17, 2008)

With the additional details about going back to the OR, I agree.  This is not routine follow up care.  You did mention anesthesia in your original post.  I should have asked for more details.  So in the end, the return to the OR and documentation will support your coding of the 2nd service.


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## lfollebout (Oct 19, 2008)

What service did he provide in the OR though?  It does seem to be extreem to do a cast change under anesthesia unless the patient perhaps was mentally challenged and combative?  Did the fracture require a manipulation?


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## sheilarichie6@hotmail.com (Jan 22, 2009)

*Air Cast Splint ????*

Need imput for coding an "air cast splint for minupulation" --applied by ortho physician in the office.  What CPT codes would be correct or should this be coded at all?    Thanks


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## mbort (Jan 22, 2009)

sheilarichie6@hotmail.com said:


> Need imput for coding an "air cast splint for minupulation" --applied by ortho physician in the office.  What CPT codes would be correct or should this be coded at all?    Thanks




what type of manipulation?  was it a fracture?  can you post the note?


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