Orthopedic Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: A patient got his cast wet, which caused skin maceration. We replaced the cast, but which codes should we use for the recasting? What about modifiers?

Montana Subscriber

Answer: If a patient gets his cast wet and requires recasting, report ICD-9 codes V54.8 (other orthopedic aftercare [change, checking, or removal of plaster cast]), the appropriate code from the 913 series (superficial injury of elbow, forearm, and wrist), 707.0 for the cast ulcer, and the fracture code, e.g., 814.00 (closed fracture of carpal bone, unspecified). For the recasting, report the cast-application code, e.g., 29075 (application; elbow to finger [short arm]), and the cast-supply code, either a Q or A code depending on carrier preference.
 
If the cast ulcer is severe enough to require debridement, you can report 11040 or 11041 in addition to the cast-application code. If your physician performed the initial fracture care and reported a global fracture care code and then performs a planned recasting, modifier -58 (staged or related procedure or service by the same physician during the postoperative period) should be appended to the cast-application code.
 
In this case, choosing a modifier is a tough call. This recasting was not planned, so modifier -58 is not an ideal fit. There was no return to the operation room, so modifier -78 (return to the operating room for a related procedure during the postoperative period) does not apply. This leaves -79 (unrelated procedure or service by the same physician during the postoperative period). Although neither modifier -58 nor -79 perfectly describes the circumstances, if the carrier requires a modifier for recastings during the global period, use one of these.