Wiki PT re evals

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mnuhfer04

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North Tonawanda, NY
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Hey all! I used to be able to bill a pt eval 97164 w/mod 59 and then also bill therapeutic exercise (97530) and get paid for both. Recently I have been getting paid only for the 97530 and denied the re eval stating "NCCI Denial for Column1/Column II Procedures with Claim Validation". I've tried looking up the NCCI edits to see if something changed where we can't bill both on the same day, but I didn't find anything (unless I missed it). Anyone have an input on this? Thanks!
 
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Still should be payable...what insurance is it? Humana is notorious for denying even with the 59 because they want medical records to verify billing is compliant. It's almost like they think the 59 is the next 25 with overuse and misuse....I'd check with the insurance and see if it they would review and reconsider w/ notes.
 
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leagle said:
Still should be payable...what insurance is it? Humana is notorious for denying even with the 59 because they want medical records to verify billing is compliant. It's almost like they think the 59 is the next 25 with overuse and misuse....I'd check with the insurance and see if it they would review and reconsider w/ note
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The insurance is Fidelis (in NY). I will be giving them a call, its so frustrating, thanks your response!
 
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Has anyone heard anything more about this? I am experiencing the same issues with Anthem. 97164 is denied when billed with 97530 stating "236- This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative."

Another claim 97164.GP.59 was billed with 97110. 97110 was denied and not paid, but 97164.GP.59 was paid on the claim.

I cannot find anything on NCCI stating they can't be billed together. Is it the modifier that's causing us trouble? I am so confused.
 
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