Orthopedic Coding Alert

Reader Questions:

Take a Closer Look Before Coding for Castings

Published on Fri Sep 08, 2023

Question: We have a physician who is a foot and ankle specialist. They have been sending patients to our therapy department to cast molds for custom orthotics. They want to start performing the casting themselves in-clinic. Would 97760 be the appropriate code for this, or is there a better code?

New York Subscriber

Answer: No. Code 97760 (Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes) would not be appropriate in this scenario. Because the provider is going to be molding the castings during this time, you should use S0395 (Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic) instead.

Take note: “Always verify using S codes with your patient’s insurance payer. Medicare, for instance, does not accept S codes, so you may not be able to get reimbursed for this service,” says Jennifer McNamara, CPC, CCS, CPMA, CRC, CDEO, COSC, CGSC, COPC AAPC Approved Instructor, CEO and physician education at Healthcare Inspired, LLC, in Bella Vista, Arkansas.

Also, you should bill out orthotics castings at the time of service, while you should bill out the orthotics themselves, usually with L3000 (Foot, insert, removable, molded to patient model, ‘UCB’ type, Berkeley Shell, each) at the time the patient receives the inserts. You are able to bill separately for the RT (Right side) and LT (Left side) orthotic if applicable. Remember that orthotics are not covered by Medicare unless they are attached to a covered brace.