Orthopedic Coding Alert

Letting extra codes for cast services slip by unnoticed or misreporting Q codes can break your bottom line. But billing all possible components and cross-checking supply codes will help you pull all the pieces together.

The American Academy of Orthopedic Surgeons (AAOS) guidelines state that you can bill for individual components of cast application when the fracture treatment does not consist primarily of a "procedure." For example, you can code all components when your orthopedist treats a closed lateral malleolus fracture that does not require manipulation and chooses not to use 27786 (Closed treatment of distal fibular fracture [lateral malleolus]; without manipulation), says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting and Education in Boardman, Ohio. The orthopedist may then code each of the patient's visits with an E/M code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) along with the application and casting supplies.

"Otherwise, if the physician chooses to report 27786 for the fracture treatment, this is global billing and the first casting application along with the removal would be bundled," Vogelberger explains.

.3 Clues Point You to the Correct Q Code

But once you code the procedure, how do you select the best Q code for the supplies? "You must identify three things to select the correct code," says Quita W. Edwards, CPC, CCS-P, COSC, CPC-I, director of billing for ActionMed Administrative Solutions in Macon, Ga. "Codes are based on the patient's age, the type of material (fiberglass or plaster), and the anatomical location."

Edwards also offers these tips for cast coding:

• Many people think you can bill a Q code only for replacement casts, but that's not the case. You can report Q codes for POS 11 (Office) every time your physician applies a cast -- even the initial treatment day.

• Some Medicare carriers require that you append modifier 76 (Repeat procedure by same physician) to the application code before they'll reimburse for replacement casts.

• If your physician treats a sprain and you can't report a global fracture care code, bill the appropriate E/M service, cast application code, and Q code instead. "I've found that many offices are often unaware that the HCPCS Level II codes can be billed from the office setting," says Vogelberger. "Networking and education are two ways to improve on this and any other coding and billing issues."

Editor's Note: Want a chart that will help you crosswalk to the correct Q code every time? E-mail the editor at leighd@eliresearch.com  with "Q Codes PDF" in the subject line for your copy.