Are Cast Re-Applications Included in the Global Period?

December 17, 2015

Question:
We are hospital employed and are being told that we cannot bill for cast re-applications in the global period. An article posted in the AAOS coding column tells us that cast re-applications are separately reportable and to append a modifier 58. We also understand that modifier 58 restarts the global period. In my old job, I was told by a billing company that post-op casting was included in the global period and was not payable unless there was a complication with the cast. Is a cast re-application billable in the global period when medically necessary and will the global period re-start?

Answer:
Thanks for your inquiry. For some readers this will be a very mundane question, but we are hearing this question more and more frequently so this is a good time to re-address how to report the services and why the services are reportable.

Let’s answer the first question first. Are cast re-applications billing during the global period? Yes! The first cast is inclusive to the global surgical CPT code, but re-applications are billable, assuming of course, that medical necessity is present. The following is the CPT citation: The very first sentence in the Application of Casts and Strapping section of CPT states, “The listed procedures apply when the cast application or strapping is a replacement procedure used during or after the period of follow-up care, or when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient.”

The answer to the second question is no, the global period will not re-start because splints and cast CPT codes have zero global days; as such, the global days cannot be reset or re-started.

*This response is based on the best information available as of 12/17/15.

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