Wiki post op casting/splinting

[anamhaidorj]

Does anyone getting denied by BCBS for post op casting? We bill our casting/ splinting with modifier LT,58 or RT,58 when patient is still in post op, lately we've been getting denied by BCBS of IL as incorrect modifier. Did i miss any policy change?

 

[kkalani]

What kind of denial are you getting? Post op casting is usually not included in the global.

 

[MI_CODER]

According to the CPT guidelines, the first cast/splint/strap application is included in the treatment of fracture and/or dislocation codes. However, the cast/strapping codes can be used when the cast/strap is a replacement procedure during or after the period of follow-up care.

With that being said, I'm not sure why BCBS is denying your claims. The first thing that comes to mind is BCBS may want the modifier that affects payment listed first (58) followed by informational modifiers (LT/RT). The second thing that comes to mind is to double check to make sure the patient is still within a global period and that modifier 58 is still needed.

Resources:
https://www.karenzupko.com/are-cast-re-applications-included-in-the-global-period/

 

[Jogan556]

Did you ever find out the reason for this? We just got a whole bunch today, same issue. (6/22/18)
Thank you.