# FX charge and casting



## CapeCodYankee (Jan 14, 2011)

Good afternoon all,

   Quick question- when seeing patient for first time & finding fracture-we bill out FX charge (say 27750)- I believe we cannot also bill/charge out the casting "application" since this is global to the fx surgical charge, BUT we CAN bill/charge out for casting "materials" upon this visit-correct?

  All replies welcome & greatly appreciated!

  Thank y'all.


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## twosmek (Jan 14, 2011)

It depends on the carrier. Medicare is a no!! but other carriers do reimburse. We as a rule don't charge for them unless it is special order materials. Then we have them sign an ABN


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## Colleen25 (Jan 14, 2011)

We always bill for the supplies (Q Code) and get paid by all carriers.   The cast application is bundled into the fracture code.  Please see this article below from The Coding Institue, hope this helps. 

*Code for Supplies Every Time*

Although cast application coding can vary, you have one simple rule to remember for cast and splint supplies: they are always separately billable, assuming your physician incurred the expense for supplies.

Look to HCPCS for all your cast supply codes. Make your selection based on the patient's age, type of cast/splint, and the type of cast material.

A codes: Some workers' compensation groups prefer A codes such as A4580 (Cast supplies [e.g., plaster]) or A4590 (Special casting material [e.g., fiberglass]). Most payers do not recognize this group of codes, however, so O'Brochta-Woodward recommends verifying their use before choosing an A code for casts.

L codes: All L codes pertain to orthotic and prosthetic procedures and devices, including scoliosis equipment, orthopedic shoes, and prosthetic implants. Only turn to L codes (such as L2106, Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom-fabricated) when you're coding supplies for long-term support of a diseased or injured extremity, not your typical fracture care.

Q codes: Your best choices lie with codes Q4001-Q4048 that cover the gamut of cast supplies and application types. Each Q code fee includes the cast material, padding, and stockinette. “Don't forget about waterproof cast padding such as Procel/Gortex,” O'Brochta-Woodward says. “Some health plans allowseparate reimbursement for this material.”

Here's how: When reporting Q codes for your cast supplies, include Q4050 (Cast supplies, for unlisted types and materials of casts). Include a note in Box 19 of the supply and type of cast applied (such as, “waterproof cast padding for short leg cast”). 

Also, include the supporting documentation of medical necessity to meet payer requirements. Diagnoses could range from 892.x (Open wound of foot except toe alone) for an open foot wound to 756.83 (Ehlers-Danlos syndrome) for EDS or friable skin.


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