Part B Insider (Multispecialty) Coding Alert

Think Q4050 is out of your reach? Think again

If you aren't billing Q codes to Medicare for your casting supplies, you could be missing out on up to $50 per claim.

Suppose a practitioner in your office applies the cast to a patient's fractured limb. You report the CPT code, and you-re all set, right? Not so fast. You-ll be writing off significant reimbursement without also reporting the appropriate casting code from the 29000-29086 (body and upper extremity) or 29305-29450 (lower extremity) series, based on the cast's location and other specifics.

Depending on payer preference, choose the supply code from HCPCS- more general -A- section or more specific -Q- section. For a plaster cast, some possible codes include A4580 and Q4005. For fiberglass, you might report A4590 or Q4006, among other codes.

-Q- Codes May Sail Through Medicare

No code exists for a combination plaster and fiberglass cast. If your physician applies such a cast, you should use Q4050 (Cast supplies, for unlisted types and materials of casts) or revert to CPT's miscellaneous supply code 99070.

Problem: Some practices balk at reporting the Q codes because they fear they-ll face a long road of denials and appeals with Medicare carriers, but seasoned coders recommend reporting these codes.

-I bill the casting codes and appropriate Q code and have no problem with reimbursement from Medicare,- says Craig Groman of the Orthopedic Medical Center in Reseda, Calif. If you-re reporting Q4050-Q4051 (Unlisted/miscellaneous cast/splint supplies), -Some carriers require a description on the claim,- Groman says. -We have found that without an ABN signed from the patient, then that part of the casting material/supply that is denied by Medicare is not collectible from the secondary insurance or the patient.- Therefore, he suggests, you may find having the patient sign an ABN appropriate and then append the GA modifier to your claim when billing Medicare.

Be careful: You shouldn't report casting or strapping codes on an initial visit when you-re already reporting fracture care, says Kara Hawes, CPC-A, coder with Advanced Professional Billing, LLC, in Tulsa, Okla. -But we always bill our Q codes for supplies, always bill x-rays, and always bill for Q4050 if the physician has indicated this supply was used,- she says.

Remember: If you write off the cast supplies, you could be forfeiting approximately $50 per claim, depending on the supply used, so always report these codes when applicable.