# Cast change during global??



## pnwcoder (Jul 7, 2011)

I know that with fracture care only the first cast is covered and any ones that need to be done after that can be charged however my question is does this also apply to surgery procedures? An example is patient has Achilles Tendon Repair and cast was applied however the next day because of swelling it is removed then 2 days later Dr applies another cast and charges out application of short leg cast. I'm thinking this is probably covered under global peroid of surgery but fracture care also has a global period and new cast app can still be charged so I'm a little confused.


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## kbrissett (Jul 7, 2011)

You can bill for the new cast but not the removal of the old one.


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## halebill (Jul 11, 2011)

Since your applications are technically a procedure, it is wise to append modifier 58 to your repeat app's during the global period (especially for Medicare). And don't forget to report your casting supplies (A4590, A4580 or Q code) separately.


Bill Hale, CPC


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## PLAIDMAN (Jul 11, 2011)

Medicare includes all casting in the global, they do not differentiate between intial and subsequent, in their global surgical guidelines.

I have not been able to find any documentation saying that Medicare has any exceptions to this rule.

I know commercial payors you can bill subsequent casting with "58"

Does ANYONE bill medicare for subsequent casting??  I thought you could NOT?


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## halebill (Jul 11, 2011)

I bill Medicare for subsequent casting everyday (and get paid for it). CPT guidelines state only the first is included in the initial procedure. If you are not billing for your re-casts (and supplies) you are leaving money on the table.


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## PLAIDMAN (Jul 11, 2011)

I know CPT says it, but Medicare does not say it, at least not anywhere I can find.  

I am looking at Medicare claims processing manual and it says casting and splinting are included in the global surgical package.

Do you know of  anything saying otherwise? Can you direct me? Or maybe something issued by Medicare saying you are allowed to charge for subsequent w/ 58?


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## halebill (Jul 12, 2011)

Please see page 92, in section B3-15011, B3-4820-4831, B. Services Not Included in the Global Surgical Package, which states:

_For certain services performed in a physician's office, separate payment can no longer be made for a surgical tray (code A4550). This code is now a Status B and is no longer a separately payable service on or after January 1, 2002. However, splints and casting supplies are payable separately under the reasonable charge payment methodology;_

http://www.cms.gov/manuals/downloads/clm104c12.pdf


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## pnwcoder (Jul 12, 2011)

Thank you for your feedback and supporting references. These forums have become an invaluable resourse as I stumble along trying to become proficient at ortho coding. So very excited to learn that my employer has decided I get to go the ortho conference that Decision Health is putting on in Sept. This time next year hopefully I'll be the one answering newbies questions instead of the other way around


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## halebill (Jul 12, 2011)

Glad I could help. We should all have questions to ask no matter how experienced, because the learning never ends in this constantly changing industry. Best wishes.


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