Wiki Casting Rules

[mhink693]

I'm wondering what the rules are on a patient coming in for a cast removal NOT in a global period. Medical decision making was done, patient had x-rays, but they are wanting to bill a 99024 because the cast was removed stating that they can't bill the cast removal. Now this would make a little more sense to me if the patient was in a global period, but aren't they missing out on revenue by not billing an E/M? I'm hoping I'm not missing something here, but I just feel like this doesn't add up.
Any help would be appreciated!

 

[thomas7331]

Yes, they can bill if it's outside the global period. But many providers won't bill because it's routine post-operative care and as a matter of courtesy to the patient and good customer service, they don't want to charge for something that they consider a normal part of the package, even if it happens to fall a little outside the global period. It can also be a matter of fairness to the patient - for example if a follow-up appointment has to be postponed due to scheduling or calendar issues and ends up outside the global period because of something beyond their control, provider won't want to charge even if they technically could. As long as it's not abused, I've always considered this a matter for provider discretion since it's their practice and their relationship with the patient that could be affected.

 

[amyjph]

Edited to remove my info that cast removal is included, I read your initial post incorrectly. You are talking about billing for the removal but the application was done during the course of an office visit and there was no surgery or non-op fracture care billed prior.

I agree with Thomas. It's just not a good p.r./relationship move in my opinion. Also, in most cases, the ortho techs and not providers remove casts. The provider is probably choosing a 99024 because they don't want to bill the patient for it.

It all comes down to the documentation.
If the patient was seen for an office visit and there is enough separate documentation to bill an E/M and the X-Ray, I wouldn't bill the removal because I am getting the other codes. If the patient comes in, the ortho tech removes the cast, the X-Ray reveals a healed fracture and the provider says, "yup it's healed bye, good luck"... would they really want to bill for removal?