Wiki Multiple Claims on Same Date of Service

[Tracey Thompson]

I have several instances in physical therapy that providers are using an EMR software which differentiates between each treatment cycle for a patient. When this happens, I am receiving two claims for the same patient, same provider, same CPT codes, but different diagnosis codes. Is this compliant?

My thoughts are that CPT codes such as 97110 are to be billed in multiple units according to the time spent on one claim with each diagnosis code also listed.

The provider's argument is that the patient is being seen for two separate injuries and is receiving two separate treatments.

Can anyone give me some enlightenment????

Thanks!

 

[creinhardt]

The CPT code mentioned does not differentiate between injuries. It is a timed code as you state for "one or more areas," so multiple treatment areas has been accounted for in the code. Also, by billing on separate claims you will run into problems with the Rule of 8. It is conceivable that therapy is rendered for 10 min. in two areas which would only allow the billing of one unit yet on two claims you would be billing two units.

Better to use a single claim and chose a primary and secondary dx.

 

[kvangoor]

I would agree with you. Some plans limit the ammount of "visits" that are payable. Seems like billing 2 different claims would result in a lower number of reimburseable units.

 

[honeybee]

Yes I agree as well combine the units and bill 2 or more different DX's instead its too difficult to get paid the other way and depending on the plan you may have no choice but to write off the duplicates. We also do PT/OT same day using GO/GP mods and even with our per diem contracts we still get paid seperatley for both although I often have to request reconsideration with notes since certain ins co take off the mods when they process and I sometimes have to resubmit too but I have always gotten the claims paid unless there is restriction to the number of unit you can bill in a day..good luck

 

[maryc@trgltd.com]

Back-up for guidance

Hello, Tracey,

The info that has been provided here is true. In concept, the same unit of time cannot be reported more than once....but its possible that the total therapy time per exercise may have been split for multiple conditions. For example, 25 minutes on a treadmill, billed 1 unit hip dx, 1 unit knee dx.......so long as the total units submitted does not exceed the total documented time (rule of 8 exception for at least 50% of time under the "unit" value).

For your own record, I pulled the CMS back-up on this calculation which also supports the general concept that each unit of time can only be "counted" once.

Thank you,

Mary Corkins
TRG
maryc@trgltd.com