Pediatric Coding Alert

Keep this handy list to distinguish between A, L, and Q code options.

Although cast application coding can vary, you have one simple rule to remember for cast and splint supplies: they are always separately billable, assuming your physician incurred the expense for supplies.

When you're ready to code for cast supplies, the answers lie in HCPCS. First, make your selection based on the patient's age, type of cast/splint, and the type of cast material. Then verify which group of possible codes the payer prefers.

A codes: Some workers' compensation groups prefer A codes such as A4580 (Cast supplies [e.g., plaster]) or A4590 (Special casting material [e.g., fiberglass]). Most payers do not recognize this group of codes, however, says Ruby O'Brochta- Woodward, BSN, ACS-OR, compliance and research specialist with Twin Cities Orthopedics in St. Louis Park, Minn. She recommends verifying their use before choosing an A code for casts.

L codes: All L codes pertain to orthotic and prosthetic procedures and devices, including scoliosis equipment, orthopedic shoes, and prosthetic implants. Only turn to L codes (such as L2106, Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom-fabricated) when you're coding supplies for long-term support of a diseased or injured extremity, not your typical fracture care.

Q codes: Your best choices lie with codes Q4001-Q4048 that cover the gamut of cast supplies and application types. Each Q code fee includes the cast material, padding, and stockinette. "Don't forget about waterproof cast padding such as Procel/ Gortex," O'Brochta-Woodward adds. "Some health plans allow separate reimbursement for this material."

Here's how: When reporting Q codes for your cast supplies, include Q4050 (Cast supplies, for unlisted types and material of casts). Include a note in Box 19 of the supply and type of cast applied (such as, "waterproof cast padding for short leg cast").

Also, include the supporting documentation of medical necessity to meet payer requirements. Diagnoses could range from 892.0 (Open wound of foot except toe[s] alone) for an open foot wound to 756.83 (Ehlers-Danlos syndrome) for EDS or friable skin.