physical therapy

  1. A

    Wiki Bundled Denial from BCBS on 97110

    I have a provider who performs peripheral nerve injections on a patient then the pt receives physical therapy by a PT on the same dos. Both services are documented separately and BCBS is denying the peripheral nerve injections as bundled to the physical therapy, stating the use of the modifier...
  2. N

    Wiki Medicare PT coding denial - 97140 and 97150

    Hello, We billed Medicare for 97140-59 and 97150. They paid the latter but denied the former stating that an accompanying code was not billed. I looked up NCCI edits and RVU values, the RVU values on 97140 are larger, so why is 97150 the column 1 code?? Does anyone have any input as to why the...
  3. C

    Wiki Billing for Outpatient Physical/Occupational/Speech therapies in the home Medicare

    I am the biller for an outpatient PT/OT/SLP clinic that bills on a CMS-1500 with POS 11 Office. We have been receiving referrals for "in home" therapy for Medicare patients. We are not a home health agency and these referrals are not for home health. Does anyone know if I can bill for therapy...
  4. M

    Wiki Virtual PT Evaluation

    Hi helpful community! We have an insured client that, due to covid, had to start her care via virtual visit. I'm not sure how to code for the evaluation as I'm not finding any virtual E/M codes for a new patient. Ideas? I know of 99499, but I'm hoping there is something more specific for...
    • MandyMW1
    • Thread
    • evaluation & management physical therapy telehealth/telemedicine telephone evaluation virtual
    • Replies: 0
    • Forum: E/M
  5. M

    Wiki Exact duplicate claim/service

    We have a patient that was sent back to us with a new diagnosis for evaluation for PT. This was <12 months after the first eval was billed, but does have the exact same line items as the first evaluation. When a patient is referred for a new evaluation for a seperate diagnosis, is there a...
  6. J

    Wiki MD and Physical Therapy same day

    Can a patient have an appointment with the MD with xrays on the same day as physical therapy? Same facility different providers.
  7. J

    Wiki Medicare 8 Min Rule Physical and Occupational Therapy

    Looking to get some information on the 8 min rule. I code for ortho (New to Physical Therapy) and our PT department bills everything by the 8 min rule. After lots of research- I know the cpt codes are 15 min time based- I know Medicare allows the 8 min. However not all insurances do, Does...
  8. C

    Wiki 97164

    Hi, This is my post in the forum and newly certified. I’m currently work in a physical therapy office. We were discussing utilizing the re-eval. code 97164. I understand that there are some guidelines when it’s appropriate to use this code. In addition that the modifier 59 would need to be...
  9. L

    Wiki Physical Therapy- billing eval/re-eval on same day as other procedures?

    I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same session, and I'm hoping someone can help. Examples: 97162 and 97530-59 : only 97530 was paid (Alaska Medicaid). 97162 denied for bundling. 97164, 97140 and...
  10. B

    Wiki Physical Therapy + Chiro Billing Software

    What's everyone using? We're contemplating migrating from Medics Premier to Kareo for these specialties. Any suggestions??
  11. T

    Wiki PT Eval billing

    Hoping you all can help me out.... One of my pain management physicians has asked and I'm not sure of the correct answer...He wants to bring a DPT into his practice be able to bill under her own tax id or the physicians tax id to get an initial pain PT consult plan. Then the patient would go out...
  12. T

    Wiki "Automatic" level 3

    Hello, My boss wants us to charge a 99213 any time a pt gets a med rx or rx to therapy. She said those are automatically level 3s. I told her that MDM is the main driver of the e/m levels, and just b/c a dr writes an rx (or more accurately, the MA enters an order into the computer) does not...
    • tamale79
    • Thread
    • e/m level physical therapy rxs
    • Replies: 17
    • Forum: E/M
  13. Z

    Wiki Physical therapy insurances that only pay for evaluation on first visit

    I'm having a hard time trying to find information about which insurances will only pay for the evaluation code for the patient's first visit with physical therapy. Does anyone know what the insurances are or where I can find that information? Thank you!
  14. M

    Wiki GA modifier during Home Health Episode

    Hi! I am having an issue with one of my practices that provides wheelchair management services by PT's and OT's for people with long term disabilities. They are occasionally running into discovering that the patient is within a Home Health Care episode. The services they provide CAN NOT be...
    • medihedgie
    • Thread
    • ga modifier home health physical therapy
    • Replies: 0
    • Forum: Modifiers
  15. H

    Wiki Physical Therapist Billing HELP!

    Hey billers out there! We have a Physical Therapist that has joined our group. We've been billing her services incident to the MD. He will be out of the office 2 days this month. Does anyone know if we are able to bill her services under the PA? The therapist is not currently credentialed with...
  16. J

    Wiki Physical Therapy

    Hi, I have recently started coding Physical Therapy for a large practice. This is a new position so there are not many resources available to me. Currently I am having trouble understanding what all falls under 97530 vs 97110 vs 97112. The Director of PT has given me a bit of insight, but...
    • jeslowery
    • Thread
    • 97110 97112 97530 physical therapy webinar
    • Replies: 0
    • Forum: Orthopaedics
  17. A

    Wiki Physical Therapy UB04 Billing Denial

    Hi all, Could definitely use some help with sudden rejections we're getting from billing secondaries to BCBS for Medicare patients. We always used UB04 forms and got paid, but now we're getting denial letters with "INVALID BILL TYPE" checked off. We've tried calling BCBS and they have been zero...
  18. A

    Wiki Unna Boot Reimbursement Issues

    How does everyone bill there Unna Boots? At our clinic, since our physical therapist does the Unna Boots, we apply a GP modifier with the appropriate LT or RT modifier. We've been doing it like that for years without any issues. Starting the year 2017 we have been getting denials due to...
  19. S

    Wiki CPC 12yr experience in medical field looking for remote full time/part time

    SKILLS •Outpatient and Inpatient Coding •ICD-10-CM, ICD-10-PCS •CPT/HCPCS Level II •Health Information Management •CMS 1500 and UB-04 Claim Forms •Healthcare Reimbursement •Medical Terminology & Anatomy •Pharmacology & Pathophysiology •3M Encoder / 3M Reference Software...
    • sas134
    • Thread
    • home health neurology physical therapy remote coding
    • Replies: 0
    • Forum: Resume Postings
  20. J

    Wiki Coding home exercises with CPT 97110 ? what is required?

    My doctor came to me wanting to bill for his time that he spends going over home exercises with patients. Is code 97110 the appropriate code? What did he need to dictate for this / what are the requirements he must meet ? Thank you !
  21. J

    Wiki PT/OT/SLP Evaluations

    I bill for Pediatric (Birth to age 3) OT/PT and Speech Therapy. I was asked recently about evaluations that aren't completed during a single session. The problem we have, is most of these kiddos can't make it through a session that is long enough to complete the entire eval. The therapists will...
  22. K

    Wiki Medicare PT and OT, different offices, different days

    Quick compliance billing question for a Medicare patient. He is currently receiving outpatient PT at our office for Parkinson's related weaknesses/pain. He also just started seeing an outpatient OT for Parkinson's related weakness/dysfunction. Will Medicare pay for two outpatient offices to...
  23. B

    Wiki PT Coding Question

    Hi! We're billing the following PT codes: 97163 97014 97010 97140 97535 All are affixed with a GP modifier for Medicare, however is a -59 needed? All of our notes seem to indicate that it's only required if billing CPT 97164 (Re-Eval). Can someone please confirm? Also, for Medicare, please...
  24. B

    Wiki 59 Modifier with PT Billing 97140

    Hi! My PT biller is out this week and I've noticed she's been billing the following the following for a single PT visit: 97140-59 97110 97026 97014 97010 According to CCI, however, I cannot find evidence of why -59 is being affixed to the 99140. Am I missing something? I know if it's done on...
  25. P

    Wiki GP, Physical Therapy Mods for medicaid plans?

    Hello all, We've been getting some denials from Fidelis for missing modifiers for physical therapy - in particular, the GP modifier. I was always under the impression that the GP or GO modifiers (for physical therapy) were only used for straight Medicare and Medicare-managed plans, but a rep...
    • Phenomenah
    • Thread
    • go modifier gp mod physical therapy pt modifier
    • Replies: 2
    • Forum: Modifiers
  26. C

    Wiki Experienced CPC looking for Remote-UTAH

    I am an experienced coder looking for a part-time remote position. I have experience in ophthalmology, physical therapy/orthopedics, risk adjustment, and EKG/ECHO. I am a very quick learner and will catch on to any specialty. I have experience in both hospital outpatient coding and physician...
  27. C

    Wiki Temporary POS Due to Flooding

    Help! A physical therapy office I help with experienced massive flooding due to the storms in SoCal. They will be unable to use their office for at lest 3-4 weeks. In the interim, they want to take their patients, who are mostly post-op surgical, to an ASC (where many of the patient's were...
  28. M

    Wiki Application of Cryotherapy Billing

    Hello All, I am in search of a CPT (if one exists) that would be suitable to use for the application of a cryotherapy device for the following reasons: Improve recovery time after intense activity or exercise Increase energy and metabolism Decrease inflammation in the body (arthritis and other...
  29. S

    Wiki OT/PT Evaluation/ReEvaluation Coding for 2017

    Hello, I previously worked for an employer who would code their OT/PT evaluations/re-evaluations with a session code depending on the length of the evaluation session - for example would code: 1 hour OT evaluation 97003 - 1 unit 97530 - 4 units (60 minutes) With the new changes for the...
  30. K

    Wiki Dry Needling CPT Code - Physical Therapy

    Hello, I am working with the Physical Therapy department regarding billing for Dry Needling here in our clinic. We have several therapists who are certified to perform this service. We have advised them to use the unlisted physical medicine CPT code 97799, considering there is not a specific...
  31. S

    Wiki Help! The VA is a nightmare

    Since Healthnet has taken over in North Carolina, there is no reasoning to which modifer they want and when. Does anyone have any guidance on what Healthnet is seeking when dealing with VA claims specific to physical therapy and chiropractic? Thanks all!
    • sherifrost
    • Thread
    • chiropractic coding physical therapy veterans administration
    • Replies: 2
    • Forum: Modifiers
  32. S

    Wiki Medicare PT Coding

    Good morning - I'm having a bit of difficulty trying to figure out just what Medicare wants when coding our PT services. I've sent 97001, 97112 (with multiple # of services) and I'm getting the CO-4 denial, which is stating that the procedure code is inconsistent with the modifier used (I...
  33. C

    Wiki S-Code 8950 Complex Lymphedema Therapy

    I work with a Physical Therapy/Rehab company. Can someone give me a good description of what is considered "complex" lymphedema therapy? How does it differ from manual Lymphedema drainage? thanks.
  34. S

    Wiki Physical Therapy Coding

    I work in an ENT/Audio office, and we are opening a balance center to meet the needs of dizzy/vertigo patients. We are employing a PT, and I was wondering if anyone knew of a good resource to go to for PT coding/billing. This is a new adventure for me, and would appreciate any assistance. I've...
Top