Wiki Billing for casting and supplies

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tldixon@mokancomm.net

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I am new at ortho coding and could use some help in the billing of casting and supplies.
If I could get my hands on some rules and regulations regarding how to bill for these....such as when I can bill for casting and supplies in a post op and when I cannot and what might get paid for by ins. companies......
Any help would be appreciated.

Thanks.
 
casting

Casts applied at surgery are included in the procedure. But you can bill for any replacement casts during po. You will need to add a modifier 58 . If a cast is applied in office, then you will need to use modifier 25 on ov, if it was determined thru exam that pt needed cast, and bill the applying cast code. Hope this helps ya. You can bill the supplies with Q codes, but most insurances do not pay. You would need to send claims for supplies to Medicare DME.
 
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HELP ! 10/16/14 PO casting dilemma

Our doc does total ankles... Post op there is a cast removal and another application - that is included in global fee ???

Pt had wound healing issues... so had to come in 2 weeks later for ANOTHER removal of cast (29705 & wound exam which required special medical honey application A6250) to wound AND another cast application (29405). Same procedure done another 2 weeks later. Diag Codes: aftercare (V54.81) and non healing wound (998.83)

Our claims are being denied after the 1st post op visit for everything ! I didn't use 58 modifier... is THAT the problem or am I NOT to bill for anything ? B/c of the wound healing - this case requires continual casting, etc.. that I explained above.
 
Just in reference to the Q codes, I've noticed that majority of insurance companies are paying for those. Whereas Work Comp and Aetna still pay for the A codes for the cast supplies.
 
somountain@aol.com said:
Our doc does total ankles... Post op there is a cast removal and another application - that is included in global fee ???

Pt had wound healing issues... so had to come in 2 weeks later for ANOTHER removal of cast (29705 & wound exam which required special medical honey application A6250) to wound AND another cast application (29405). Same procedure done another 2 weeks later. Diag Codes: aftercare (V54.81) and non healing wound (998.83)

Our claims are being denied after the 1st post op visit for everything ! I didn't use 58 modifier... is THAT the problem or am I NOT to bill for anything ? B/c of the wound healing - this case requires continual casting, etc.. that I explained above.
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You cannot include the cast application in the initial visit because it is included in the procedure, but if the patient is coming back during the global period for another cast application you would need the -58 modifier on the cast application.
 
What about, if the provider charges a fracture care code (90 days global). Pt comes back a month later - he removes the cast and replace it with a splint? Can we bill for the splint?
 
Is anyone getting told by Aetna that they will only pay 1 within 90 days? I cannot find a policy that explicitly states this and we have a patient who had surgery and is coming in basically every 7 days for a new short leg cast. Aetna paid for 5 of them from 2/1/24 to end of March but now denying saying they will only pay 1 every 90 days. The other weird thing is some have mod 58, some don't and they were paid, recouped, then repaid. I am sure it is only a matter of time before they recoup for good but I am just utterly stumped on this.
 
mgleason7 said:
Is anyone getting told by Aetna that they will only pay 1 within 90 days? I cannot find a policy that explicitly states this and we have a patient who had surgery and is coming in basically every 7 days for a new short leg cast. Aetna paid for 5 of them from 2/1/24 to end of March but now denying saying they will only pay 1 every 90 days. The other weird thing is some have mod 58, some don't and they were paid, recouped, then repaid. I am sure it is only a matter of time before they recoup for good but I am just utterly stumped on this.
Click to expand...
Yes, we just received denial with Aetna, stated benefits only allow for 3 within 90 days, denied the 4th and 5th cast change.
 
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