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AEllis89

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I have a few PTs in the ED where the provider came in for a consult and not sure if I should be using the 99281–99285 codes or use an outpatient E/M code.
 
What service is being performed? An eval (9716X)? PT treatments such as 97110, 97140, etc.? Why would E/Ms be used for PTs? I don't think PT/OT/ST are allowed to bill E/Ms at all. They are not physician or NPPs.
https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf (See E/M section 30.6)
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf (This has all the definitions)

Definitions
Physician is a Doctor of Medicine, osteopathy, podiatric medicine, optometry (only for low vision rehabilitation).
NPP is a Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP).
Qualified Therapist includes a PT, OT, or SLP who meets regulatory qualifications as applicable, including state licensure or certification.
Sections 230.1–230.3of Medicare Benefit Policy Manual Chapter 15 has more information

There is a component with special rules for hospitals and under arrangement that would have to be looked into depending on the facility and employment, etc. There is a whole section about special rules for hospitals in the manuals. The staff coder should not be making these decisions. Are you billing for the individual PT profee, under arrangement, group, contract, etc.? The hospital facility?

You would also have to check individual health plans for their PT/OT/ST rehabilitation policies.
 
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