Wiki Fx Global Period/Splinting & Casting

[ahonkomp]

I work in the Family Practice setting and fracture care coding is very challenging for me.

If I am billing the 90 day global fracture care code of 25605 (Closed treatment distal radius fx and ulna when performed with manipulation), Can I charge for splint and/or cast applications (ex. 29125 or 29075) in this 90 day period? Or only charge for the supplies (ex. Q codes, L codes)? Any input would be much appreciated and references if possible.

Thank you so much!

 

[dclark7]

You would not charge for the initial cast application, that's included with the fracture code, but you can charge for the supplies. You can charge any subsequent casts but add a 58 modifier to the cast application code. You can also charge for the subsequent supplies (Q codes, I can't think of any L codes for cast supplies)

 

[ahonkomp]

So in my situation, the fracture care was initiated in the ER. At the ER visit, a sugartong splint was applied. At the subsequent office visit, the patient still had swelling so another sugartong splint was applied. At a 3rd visit, a short arm cast was applied. At a 4th visit, the cast was removed and she was given a prefabricated splint (an L code). Then finally, at a 5th visit, she was told she could discontinue the splint and resume normal activity as tolerated.

Does it sound like any of this is separately billable outside of the global care(besides the supplies)? I guess I get caught up on "initial cast application"...

I do very much appreciate your assistance!!

 

[dclark7]

If your doctor saw the patient in the ED the fracture care code can be charged, no cast application since that's included in the fracture code, no supplies, those would be charged by the hospital. (If the ED doc saw the patient they should have billed an ER visit and the application of the splint.) If your doc did the initial ER care and charged the fracture code, on the second visit (first office visit) 99024, the splint application with a 58 modifier and the supply codes would be billed. On the third visit 99024, the cast application with 58 modifier and supplies, fourth 99024 with the L code and fifth 99024 only.

Initial cast application only means the first cast/splint applied.