Wiki 97140 & 97530?

[keke74]

Hello, 97140 & 97530 may not be billed together due to they are Mutually exclusive, however a modifier is allowed. Would you add a modifier 59 or just bill the 97530(therapy)? Any help would be appreciated!

 

[jmcpolin]

Our providers do both so we bill both per NCCI it does not matter which code you put the 59 on but we have found they both get paid if we put it on 97530.

 

[orthobiller2000]

Here is why you need 59 on 97530 vs 97140:

Per CPT®/HCPCS to CCI Code Check Code Description Modifiers Non-Facility RVU

97530 THERAPEUTIC ACTIVITIES M RVU 0.99
Code 97530 is mutually exclusive with code 97140 but a modifier is allowed in order to differentiate between the services provided.

97140 MANUAL THERAPY M RVU 0.84
Code 97140 is mutually exclusive with code 97530 and cannot be billed using any modifier.

Hope that helps

 

[Kimmers]

CCI edit shows when 97140 is paired with 97530 that, if your notes support that the procedure is distinctly separate and identifable, you are allowed to add the modifier 59 to 97530.
Your documentation must be clear.