podcoder70
Expert
Please help me find information as to the coding rules for these "sometimes" therapy codes as related to treatment provided by an MD or FNP NOT employed by the home health agency. The two codes are being denied, the diagnosis codes are not the issue. POS is 12. Patients are being followed by a home health agency. The treating provider is treating an appropriate wound. There may be a therapy plan of care in place with the home health agency, however, since the treating provider is not associated with the HH agency, the provider is billing for their own services.
I have read everything I can get my hands on. Some of what I have read, including a post in AAPC which states "Any sometimes therapy service that is provided as an integral part of a therapy POC must be billed with a therapy modifier regardless of the providing professional’s credentials, including physician, non-physician practitioner (NPP), or psychologist. Any sometimes therapy service that is not appropriately part of a therapy POC and is provided by a non-therapist (i.e. physician, NPP, psychologist, or therapist working incident-to the physician/NPP) should not be billed with the therapy modifier.
Is it appropriate to use the GP modifier when the treating provider is NOT the provider that created the plan of care?
I have read everything I can get my hands on. Some of what I have read, including a post in AAPC which states "Any sometimes therapy service that is provided as an integral part of a therapy POC must be billed with a therapy modifier regardless of the providing professional’s credentials, including physician, non-physician practitioner (NPP), or psychologist. Any sometimes therapy service that is not appropriately part of a therapy POC and is provided by a non-therapist (i.e. physician, NPP, psychologist, or therapist working incident-to the physician/NPP) should not be billed with the therapy modifier.
Is it appropriate to use the GP modifier when the treating provider is NOT the provider that created the plan of care?