97597 and SNF Consolidated Billing

[joy7ann]

If our doctors see a Medicare patient residing in a SNF in a our office and perform a debridement 97597 Cahaba is denying us payment. They claim if we use this code we are not exempt from Consolidated Billing and must bill the SNF for payment of the claim.
Has anyone else run into this scenario?

 

[TiffanyParks]

CMS states:
-Physicians' services furnished to SNF residents. These services are not subject to CB and, thus, are still billed separately to the Part B carrier. HOWEVER...
-Section 1888(e)(2)(A)(ii) of the Social Security Act specifies that physical, occupational, and speech‑language therapy services are subject to CB, regardless of whether they are furnished by (or under the supervision of) a physician or other health care professional.

Since 97597 falls under the CPT category "Physical Medicine" they are correct with their denial.

Tiffany Parks, CPC

 

[werner03]

The nursing home would have to pay the physician who had done the services if he wants to be paid.

Katie Werner, CPC, CPMA