Pediatric Coding Alert

Question: When a physical therapist (PT) or an occupational therapist (OT) who works in our pediatric clinic casts a patient's legs or arms with part plaster and fiberglass, how should I code for the supplies?

Answer: When a PT or OT applies the cast, check whether the service meets "incident-to" requirements. If a pediatrician orders the casting and directly supervises the procedure, you should bill the procedure with a casting code such as 29065 (Application, cast; shoulder to hand) and the supply (e.g., Q4007, Cast supplies, long arm cast, pediatric [0-10 years], plaster) incident-to the physician.

On the other hand, if a pediatrician applies the cast, you should report a CPT and HCPCS code. Use the appropriate casting code from the series 29065-29085 (body and upper extremity) or 29345-29450 (lower extremity), based on the cast's location and 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 (Cast supplies [e.g., plaster]), Q4005 (Cast supplies, long arm cast, adult [11 years +], plaster), Q4007, Q4029 (Cast supplies, long leg cast, adult [11 years +], plaster) and Q4031 (Cast supplies, long leg cast, pediatric [0-10 years], plaster).

You may report a fiberglass cast with A4590 (Special casting material [e.g., fiberglass]), Q4006 (Cast supplies, long arm cast, adult [11 years +], fiberglass), Q4008 (Cast supplies, long arm cast, pediatric [0-10 years], fiberglass), Q4030 (Cast supplies, long leg cast, adult [11 years +], fiberglass) and Q4032 (Cast supplies, long leg cast, pediatric [0-10 years], fiberglass).

No code exists for a combination plaster and fiberglass cast. If your pediatrician 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 (Supplies and materials [except spectacles], provided by the  physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).