Wiki Medicare Denial 97035

[MedCoder606]

I work for a podiatrist. Beginning of this year I get denials from Medicare on 97035. This code falls under physical therapy and I have looked at MLN article MM8005 on how to bill this code. I know it needs G codes & needs severity modifiers CH through CN. I can't figure out what G-codes & modifiers to submit with 97035. I know it needs GP modifier. Has anyone else had this problem or bill this code? I appreciate any help I can get.

Kathy, CPC

 

[polcollinski]

According to the denial, are they asking for G codes for the 97035 ? According to MM8005, the 97035 is not an evaluation. I was under the impression that only evals required G codes.

 

[MedCoder606]

That's what I thought when I read the article... I thought that it only needed GP modifier - but that is not what Medicare is telling me....& MC won't tell what G codes to bill with it... I am so confused - and I can't find anyone that bills 97035...

 

[mitchellde]

Google functional status codes and you should find what you need.

 

[MedCoder606]

I have already done that - don't see any article that requires functional G codes for 97035

 

[shelia_j]

Severity Modifiers

As a coder it is not your responsibility to assign a severity modifier. The severity modifier provides clinical information to Medicare and other payors that describe the patient's condition/level of impairment. Coders should not assign diagnosis codes or clinical indicators.I would ask the provider to check off the services provided on a charge ticket or superbill, and I would ask the doctor to provide the severity modifiers. The provider must make this determination based on the preformance of an evaluation/exam, assign severity modifers based on the patient's current status and projected goal status. Assigning severity modifers has nothing to do with coding. Those modifers are based on clinical judgement and providers often use a tool to help make the determination.