# modifiers on application of cast



## desertsteph65 (Oct 16, 2012)

we have a dispute in the office in regards to application of cast during initial office visit. I have been charging an office visit with a 25 modifier, then (example) 29065 (L-R) and material Q4006. Now it has come to my attention that billing says I need to put a -59 on 29065. This is news to me. Can anybody help resolve this issue??
Stephanie Walters, CPC


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## MMadrigal (Oct 16, 2012)

*mod 59 with cast application*

never heard of this.  Have always used mod-25 on the E/M and RT/LT on the cast.  Mary


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## desertsteph65 (Oct 17, 2012)

Everything I have found so far is telling me that the cast application is included in the initial C/T (25600 etc) charge. You can charge for cast application on subsequent visits during the global period. Has anyone found anything different to contradict this?


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## armen (Oct 17, 2012)

desertsteph65 said:


> Everything I have found so far is telling me that the cast application is included in the initial C/T (25600 etc) charge. You can charge for cast application on subsequent visits during the global period. Has anyone found anything different to contradict this?



First cast application is always included in Fracture Care code, so you can bill only cast supplies. You need to append modifier 57 to your E/M code instead of 25 since Fracture Care codes have 90 days global. And appending modifier 59 to cast application code is totally wrong.


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## monica03 (Oct 18, 2012)

armen said:


> First cast application is always included in Fracture Care code, so you can bill only cast supplies. You need to append modifier 57 to your E/M code instead of 25 since Fracture Care codes have 90 days global. And appending modifier 59 to cast application code is totally wrong.



You will have to put a 58 modifier on the application of the cast if there are any cast changes during the global period.


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## desertsteph65 (Oct 18, 2012)

Thank you so much.

Our billing people have been doing it all wrong all this time. Even changing my coding because "they paid for it if they code it that way". It never made sense to me that if you charge for C/T of a fracture that would charge for application of a cast. I too would pick modifier 58 for a cast during the global but they wanted a 59 on it. I now have the documentation I needed. 

Thanks again.


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## raidaste (Oct 19, 2012)

I'm not understanding the need for 58 on cast changes during the global. I've never put 58 on them because they are not considered part of the global charge so you can bill the replacement cast applications with modifier 58. The first few that I did add 58 to because that's what I was told to do, denied as modifier used is not needed. I do agree with putting 57 on the e/m for the initial and then the RT/LT on the fracture care code.


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## OCD_coder (Oct 25, 2012)

Before applying modifier 58 to a cast application in a global period.  Please take a look at the CMS Global Surgery Fact Sheet, cast supplies are billable - actual casting/splinting is inclusive of the major procedure global package.  This item was pointed out to us by a representative of our MAC after a major take back for a 3 year period.  It was news to us as we always understood that cast application after the initial surgery procedure would be billable.

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf


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## jplichta (Oct 29, 2012)

Michelle do you have documentation from the MAC rep regarding this that you could send me?


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