Orthopedic Coding Alert

Question: Im having trouble getting paid for casting supplies (casting material, padding and tape) from carriers using A4590. Am I billing these incorrectly?

Michigan Subscriber

 
Answer: If the problem is limited to Medicare, the problem may be that you are reporting an obsolete code. As of July 1, 2001, Medicare no longer processes claims submitted with HCPCS codes A4580 and A4590. New temporary Q codes have been created for cast supplies. These Q codes are specific to the type of cast applied and the patient classification (pediatric versus adult). Some non-Medicare payers may now accept these codes, and you may want to poll your major payers on this issue.
 
The August 2001 edition of Orthopedic Coding Alert has a comprehensive article on the new codes, and the Medicare program memo detailing them can be viewed at www.hcfa.gov/pubforms/transmit/AB0160.pdf.
 
Check with your local Medicare carrier to see if it has a local medical review policy (LMRP) on cast supplies. Several states do, and this allows for payment for cast supplies used when treating a fracture, but prohibits it at other times. If a cast is applied for any other reason, such as after an ankle fusion surgery, the cast supplies may not be reimbursed.
 
If you are experiencing denials from other carriers, youll need to do some research. Some payers do not cover cast supplies. If you are contracted with the payer, you cant make the patient pay. If you are not contracted with the payer, tell your patients that cast supplies may not be a covered expense and that they may have to pay out-of-pocket. An advance beneficiary notice is not needed if the practice finds out from the local Medicare carrier that supplies are not covered for certain, specific circumstances.
 
Answers to Reader Questions and You Be the Coder provided by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J.