Wiki Modifier for coding Physical Therapy

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neha.bhatnagar

neha.bhatnagar

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:)Hi Friends,

Please help me with this :confused:

An Internal medicine provider given Physical Therapy to patient. It consisting of total 4 CPT's . Those are as follows :

1) CPT 97032 [electrical stimulation (manual), each 15 minutes]
2) CPT 97010 [hot or cold packs]
3) CPT 97140 [ Manual therapy techniques each 15 minutes ]
4) CPT 97035 [Application of a modality ultrasound, each 15 minutes]

How do we code for all these procedures if performed on same day ?
Do we need to add 59 modifier to any of the procedure ?
Do we need to add modifier 26 or TC with CPT 97035 as it is an instrument ?

Thanks.
Neha Bhatnagar, CPC, CPC-H
 
Hi,

How do we code for all these procedures if performed on same day ?
We can code all these codes for the same DOS.

Do we need to add 59 modifier to any of the procedure ?
NO, they don't need any modifier as they have no edits (only 97010 and 97035 has edits till 1997)

Do we need to add modifier 26 or TC with CPT 97035 as it is an instrument ?
we no need to add mod 26 or TC with 97035, (it is not an diagnostic instrument).

Joseph Amalraj Antonisamy CPC-H
 
Last edited:
Physical therapy

We just started doing this in our practice (internal medicine/nephrology) 97032 and 97035 so far we found physical therapy modifier gp and a possible g code for 97032 for medicare beneficiary we are waiting for a response from ins. Anyone else know anything on how to bill these codes it would be helpful to share the knowledge.

Thanks
 
we just recieved payment for 97032 and 97035 on the same day with modifier gp on both procedure codes just an fyi
 
Modifier usage

I use a 76 modifier when using 97032 and 97035 on the same date of service for non Medicare insurances and the group code for Medicare. Does anyone get paid for hot or cold packs? I have a couple that pay about $5 and some not at all.
Candy
 
We bill for hot and cold packs but it's often not reimbursed or if it is, it's about $5.
 
ccarver said:
I use a 76 modifier when using 97032 and 97035 on the same date of service for non Medicare insurances and the group code for Medicare. Does anyone get paid for hot or cold packs? I have a couple that pay about $5 and some not at all.
Candy
Click to expand...
Why are you using a 76? 97032 and 97035 are two different codes. 76 is for a repeated service so you would have to use the same code and the exact same service must be repeated. Not the same thing as the same procedure performed on two different areas.
 
Probably not

Only if the Doc is a licensed PT:

(225 ILCS 90/2) (from Ch. 111, par. 4252)
(Section scheduled to be repealed on January 1, 2016)
Sec. 2. Licensure requirement; exempt activities. Practice without a license forbidden ‑ exception. No person shall after the date of August 31, 1965 begin to practice physical therapy in this State or hold himself out as being able to practice this profession, unless he is licensed as such in accordance with the provisions of this Act. After the effective date of this amendatory Act of 1990, no person shall practice or hold himself out as a physical therapist assistant unless he is licensed as such under this Act. A physical therapist shall use the initials "PT" in connection with his or her name to denote licensure under this Act, and a physical therapist assistant shall use the initials "PTA" in connection with his or her name to denote licensure under this Act.

Lin
CPC CFE
 
When billing medicare and medicaid for physical medicine codes, you must use modifier GP for physical therapy and GO for occupational therapy. Check with your state licensing board prior to using these codes for someone other than a PT or OT. Also, medicare does not pay for hot/cold packs, but most private insurance companies do. You do not use any other modifiers for these codes.
 
PT for 97022 and 97124 together plus modifiers

We are outpt PT. We have a tx plan approved by an MD. Our PTA performed the therapy under the supervision of a PT. THis is not a medicare plan. My chosen CPT codes are 97022 and 97124. It is a hip problem. Do we need a modifier 59 on the second code? And, do we need to use the GP modifier on one or both of the codes? Any feedback? :confused:
 
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