Orthopedic Coding Alert

Question: Our office manager suggested we report A4590 instead of a Q code for waterproof casting (Gortex) materials. Is this appropriate, and how do we handle the claims with Medicare?

Indiana Subscriber

Answer: None of the Q codes -- including the 'catchall' code Q4050 (Cast supplies, for unlisted types and materials casts) -- mentions a category that would include Gortex, so you can use A4590 (Special casting material [e.g., fiberglass]) instead.

Medicare check: Call your Medicare administrator to verify its policy on waterproof casting supplies. If the carrier won't pay, ask the patient to sign an Advance Beneficiary Notice accepting responsibility for the cost.

Then submit the claim with the appropriate ABN modifier: GA (Waiver of liability statement on file), GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit), or GZ (Item or service expected to be denied as not reasonable and necessary).