99213, 97032, & 97035

LDWICK24

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What modifiers should be applied to these CPT codes on a claim? Only the modifier 25 has been applied to the 99213 and this CPT paid, but the 97032 & 97035 have denied with the following explanation: CO4 "The procedure code is inconsistent with the modifier use OR a required modifier is missing.
How should this be billed?
 

CodingKing

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Medicare, Medicaid, Commercial? What specialty and payer? Could be mod 59 to show they are significant and separate from the E&M. Some payers may want a modifier to show if the modalities are under a PT, OT plan of care.

for instance

[h=2]Therapy code modifiers[/h]
  • GN: Indicates services delivered under an outpatient speech-language pathology plan of care
  • GO: Indicates services delivered under an outpatient occupational therapy plan of care
  • GP: Indicates services delivered under an outpatient physical therapy plan of care
 
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