Question Code 97016

vnorman

Networker
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50
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We are currently using a billing company for some of our services (something I do not agree with) and they are billing code 97016 twice with a modifier of -76 on the second charge. The services we are performing are being performed at the same session and not as a subsequent visit or session. Everything I am reading indicates this is not correct, that code 97016 is for ONE or MORE areas during the same session. Am I reading this incorrectly or am I correct that the billing company is billing our services wrong?
 

Orthocoderpgu

True Blue
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Full disclosure, out of everything I know physical therapy coding is at the bottom of the list. However in looking at this I am with you. I can't see how they are using modifier -76 correctly and the way that they are using it would be a huge red flag "Come audit us"! The need for using -76 on 97016 would be rare. I hope someone who is actually familiar with PT coding/billing can give better details, but so far I am with you.
 

vnorman

Networker
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Thank you very much for the information. This is what I was thinking also but wanted to confirm. This is just one more reason why I do not like or trust billing companies. They typically do not have a coder on staff and bill just because something will pay.... well that does not make it right!
 
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