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 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