Orthopedic Coding Alert

Question: A diabetic patient is seen in the hospital for foot pain. Multiple tarsal and metatarsal fractures are noted, and charcot diabetic arthopathy is the underlying cause. The treatment will consist of several casting changes every two to four weeks and may last six to 12 months. Should we bill individual visits and cast application, or fracture care for the first 90 days then individual visits?

Roy J. Guse, MD
Texas Specialist Center

Answer: Follow-up casting may be billed even during the global period of fracture care. Fracture care codes only include the initial casting.

Any follow-up casting can be billed as performed, using a code from the cast series and appropriate supplies from the HCPCS codes (A4580, cast supplies, [e.g., plaster]; A4590,special casting material [e.g., fiberglass]). It would not be appropriate to code individual services instead of fracture care just to circumvent the 90-day global period or for the purpose of obtaining greater reimbursement.