August 2001 Bulletin

New cast supply codes generate questions

Q codes effective July 1 for carrier processed claims, Oct. 1 for intermediary processed claims

Q. I thought that we were to use these Q codes only when a reduction was done at the time of service. But I guess we are to use these for everything related to a supply code when it is a fracture/dislocation. Do you have suggestions as to how to do this in an office?

A. Yes, these new Q codes are to be used anytime you apply a cast or splint for fracture or dislocation care. They are taking the place of the A4570, A4580 and A4590 codes. In an office setting you will need to have a place on the superbill for the provider to indicate, plaster or fiberglas, adult or child, and then to tell what was applied, SAC, LAC, LLC, SLC, etc.

Q. In light of the fact that the Q codes now replace HCPCS code A4570, are we able to bill Q codes out on units, i.e., by number of rolls used?

A. Currently, CMS (Centers for Medicare and Medicaid Services, formerly known as HCFA) is allowing Q codes to be reimbursed by Medicare on an application-type basis. That means that it is 1 unit per cast. Unfortunately, CMS has not stated how they came up with this dollar amount. Offices need to figure out the cost of all supplies related to a given cast, such as short arm cast, and possibly use that as their fee for cast materials. All supplies should include, stockinette, padding, plaster or fiberglass material.

Q. Since the Q codes came out for cast material and the Program Memo states not to use the A codes, does that just apply to Medicare or all carriers? Should I expect all carriers to accept these codes?

A. The Program Memo was geared towards Medicare, however, you will want to check with your carriers to find out if they are recognizing the Q codes or if they will allow you to use the A codes until the first of the year.

Q. I had been told that the Q codes only apply to home health patients or those treated in a stand-alone outpatient facilities and could not be used in a hospital system. Any truth in this?

A. If you look at the Program Memo relating to these new codes it states: "The payments for casting and splinting supplies provided in hospital outpatient departments and ambulatory surgical centers are unchanged by this PM. To the extent these services are provided by home health agencies and to hospice patients for the treatment of a nonterminal illness, the payments for these services are also unchanged. These facilities continue to utilize the appropriate codes in the 29000 through 29750 series of the HCPCS Level I codes. The Q codes will be added in the Oct. 1, 2001, version of the Outpatient Code Editor, so their use in these settings will not be implemented until that date."

So, according to the Program Memo, hospital outpatient departments and ASCs do not need to start using the Q codes until Oct. 1, 2001. The Program Memo goes on to state, "The remainder of this PM applies to carriers processing claims with dates of service on or after July 2001, and FIs (Fiscal Intermediaries) processing claims for CORFs (Comprehensive Outpatient Rehab Facilities) and ORFs (Outpatient therapy facilities) with dates of service on or after Oct. 1, 2001." If providers are in an office setting they should be using these Q codes as of July 1, 2001.

Q. My understanding is that the A4580 and A4590 HCPCS codes will be replaced with more cross-walked application codes which are the Q4001-Q4048. How do I know which HCPCS will cross over with, for instance 29065, since there is a range of Q4005 through Q4008? I have been told that since I have three months (through Sept. 30, 2001) before I must use the Q codes it will be explained in future MCR Updates. Do you have any clarification?

A. For a complete description of what all the new Q codes mean, you will find it in the actual program memo:

Physicians will have to tell the coder/biller if the patient is older than 10 years old, and whether plaster or fiberglas is used so that the correct code can be used. That is why the Coding Corner article in the June 2001 AAOS Bulletin has an example in the third paragraph stating that 29365 could be linked to Q4034, but that now there are four cast material codes for some cast applications.... I would recommend going to www.hcfa.gov/pubforms/transmit/ab0160.pdf where you will find the full description of the codes.

The full description of the codes is shown in The 51 new Q codes for cast supplies article.

Q. What Q codes do I use for reimbursement for conservative treatment of sprains/strains with casting?

A. HCFA has not stated how treatment of strains/sprains with casting is to be handled. Everything currently is geared towards fracture and/or dislocations. HCFA has stated that they will be addressing this issue in a upcoming Program Memo.

Margie Scalley Vaught, CPC, is an independent coding specialist in Ellensburg, Wash. She also is a member of the American Academy of Professional Coders National Advisory Board.

Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.


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