Orthopedic Coding Alert

But heed payers’ A and Q code preferences — or pay the price.

Suppose a practitioner in your office applies the cast to a patient’s fractured limb. You report the CPT® code, and you’re all set, right? Not so fast. You’ll be writing off significant reimbursement if you aren’t also reporting the appropriate supply code.

Depending on payer preference, choose the supply code from HCPCS- more general “A” section or more specific “Q” section. For a plaster cast, some possible codes include A4580 (Cast supplies [e.g., plaster]) and Q4005 (Cast supplies, long arm cast, adult [11 years +], plaster). For fiberglass, you might report A4590 (Special casting material [e.g., fiberglass]) or Q4006 (Cast supplies, long arm cast, adult [11 years +], fiberglass), among other codes.

Plan Ahead for Medicare Patients

No code exists for a combination plaster and fiberglass cast. If your physician applies such a cast, you should use Q4050 (Cast supplies, for unlisted types and materials of casts) or revert to CPT®’s miscellaneous supply code 99070 (Supplies and materials, (except spectacles) provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).

Problem: Some practices balk at reporting the Q codes because they fear they ll face a long road of denials and appeals with Medicare carriers, but seasoned coders recommend reporting these codes.

If you’re reporting Q4050-Q4051 (Unlisted/miscellaneous cast/splint supplies), some carriers require a description on the claim. Some coders have found that without an ABN (Advance Beneficiary Notice) signed from the patient, then that part of the casting material/supply that is denied by Medicare is not collectible from the secondary insurance or the patient.

What to do: Have the patient sign an ABN, and then append modifier GA (Waiver of liability statement issued as required by payer policy, individual case ) to your claim when billing Medicare.

Be careful: You shouldn’t report casting or strapping codes on an initial visit when you’re already reporting fracture care.

Remember: If you write off the cast supplies, you could be forfeiting well-deserved reimbursement per claim, depending on the supply used, so always report these codes when applicable.