Can the application of a below the knee, non-weight bearing fiberglass cast be billed for in order to treat a fracture?
This is an interesting scenario. A patient was apparently seen by a physician who diagnosed the patient with a minimally displaced fracture of the distal fibula. The patient was then referred to a non-associated, unrelated physician to follow up for the treatment of the fracture. The question is whether the application of a below the knee, non-weight bearing fiberglass cast can be billed for?
In reality, there are a few options:
Option #1:
1. Since this is a new patient for the second physician, an Initial E/M service can be billed. Based upon the fact that the issue at hand is an acute, uncomplicated injury with a low risk of morbidity from additional diagnostic testing or treatment, 99203 would be appropriate to bill.
2. Unless the diagnostic X-rays that were obtained by the initial physician were provided to the subsequent physician, I believe that it would be a really good idea to obtain radiographs of the affected ankle. CPT code 73610 would be appropriate to bill. CPT code 73610 is defined as radiological examination; ankle; complete, minimum of 3 views.
3. As far as the application of the cast is concerned, the most appropriate CPT code to bill would be 29405 which is identified as Application of short leg cast (below knee to toes).
4. Of course, the materials for the cast should be reimbursable. The appropriate HCPCS Level 2 code would be Q4038 which is defined as Cast supplies for short-leg cast, Adult (11+ years), fiberglass.
The coding scenario would be the following:
99203 – 25 - The 25 modifier would need to be appended. It is defined as the following: SIGNIFICANT, SEPARATELY IDENTIFIABLE E/M SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE.
73610 – RT/LT
29405 – RT/LT
Q4038
Option #2:
1. Since this is a new patient for the second physician, an Initial E/M service can be billed. Based upon the fact that the issue at hand is an acute, uncomplicated injury with a low risk of morbidity from additional diagnostic testing or treatment, 99203 would be appropriate to bill.
2. Unless the diagnostic X-rays that were obtained by the initial physician were provided to the subsequent physician, I believe that it would be a really good idea to obtain radiographs of the affected ankle. CPT code 73610 would be appropriate to bill. CPT code 73610 is defined as radiological examination; ankle; complete, minimum of 3 views.
3. Why not treat the fracture? The most appropriate CPT code to bill for this fracture would be CPT code 27786 which is defined as the following: Closed treatment of distal fibular fracture (lateral malleolus); without manipulation.
4. The application of the cast would be bundled and included with the fracture treatment CPT code 27786.
5. The materials for the cast should be reimbursable. The appropriate HCPCS Level 2 code would be Q4038 which is defined as Cast supplies for short-leg cast, Adult (11+ years), fiberglass.
The coding scenario would be the following:
99203 – 57 - DECISION FOR SURGERY - Modifier 57 is used to identify an E/M service, provided on the day before or day of surgery, in which the initial decision is made to perform major surgery (90 day follow-up). The “Global Surgery Policy” includes the E/M service provided on the day before or the day of the major surgical procedure unless the E/M service resulted in the decision to perform surgery. CPT code 27786 is classified as a major surgical procedure code with a 90 day postoperative global period.
73610 – RT/LT
27786 – RT/LT
Q4038
This is my opinion.
Michael G. Warshaw, DPM, CPC
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