Eli's Rehab Report
Therapeutic Activities and Exercises
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Nevada Subscriber
Answer: There is no CCI edit prohibiting you from billing 97530 (therapeutic activities, direct one-on-one patient contact by the provider [use of dynamic activities to improve functional performance], each 15 minutes) and 97110 (therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) together for the same patient on the same day.
But some carriers still deny payment for both of these together, stating that they are not both medically necessary and that only one should be billed. If this happens to you, send your carrier an appeal letter justifying the need for both services, along with a copy of the CCI edits for both codes.
In your letter, note that these codes are not bundled and request specific written direction regarding what policy prohibits you from billing these codes together. Otherwise, you should continue submitting codes for both modalities on the same day if you perform them under a covered ICD-9 code and they are medically necessary for the patients condition.
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