Wiki Shared fracture care

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coder1956

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Pt is seen in ER for a fracture that is reduced and a cast is placed. The patient follows up with Ortho where the cast is removed and another is applied.

The ER doc should report the CPT code with the -54 modifier. The Ortho doc should report the CPT code with modifier -55 and the casting procedure since it is not the first cast of the CPT code.

Here's my question: Would anyone use the -59 modifier before the anatomic modifier to indicate that this is not the first cast of the CPT code and that it is a distinct procedure separate from the CPT code and is appropriate to report? The -55 wouldn't necessarily tell the story because it is possible that the first provider didn't place a cast and that the follow up provider would be applying the first cast of the procedure code.

Thanks in advance for any responses.

Susan
 
The CPT code includes the application of the first cast/splint, doesn't matter when, just that the first one cannot be reported separately. How will the second provider indicate that his/hers is not the first cast? The -55 modifier wouldn't cover that because the first provider may not have applied a cast/splint. If one was not applied, the second provider could not report the application code. Seems like the only way to indicate that the cast was not the first one would be with the -59 modifier.
 
No cast or splint in ER

If the ER didn't provide a cast or splint how did they "treat" the fracture in order to bill the fracture treatment code? If no cast or splint was applied, then the ER most likely did not provide fracture care and would not have billed the fracture treatment code with -54 modifier.

The -55 modifier says that the "second" physician is providing ONLY postoperative care. Therefore, by definition, and casting done is a "re-casting" and is separately coded.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
So are you indicating that an ER provider will always apply a cast/splint after a restorative procedure? Wouldn't there be times when a cast or splint was not applied after the restorative procedure but the CPT code should be reported with the -54 modifier? Since that is a possibility it seems that the -59 should be appended to the casting for my original example.

Thanks for the replies.

Susan
 
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