New or Established EM Code for Physical Therapy?

gr8gal61

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I have a question re: new or established patient E&M coding. Typically in a M.D., D.C. or D.O. facility the AMA guidelines are clear & precise however with a Physical Therapy facility, the therapist are not "physicians". If a patient has been seen in this facility, within three years however their visit is due to a different injury are they considered a new patient or established? I believe the answer to be that it doesn't depend on the DX of the patient however if the patient was seen in this facility or not! Please help as I'd like to be coding & billing correctly. Thanks
 

pamley11

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It may depend on the insurance of the patient. More specifically, if they are workers comp.

I was in a meeting recently and she used a PT facility as an example and said there was a new w/c ruling that with any new injury (even if it's only 1 week apart), the patient is considered a new patient.
 

takore

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No E/M for PT specialty

Hi,

If my trainer was right, she stated that PT specialist can't bill E/M but use 97001 or 97002 instead. I'm pretty new to the industry so I can't deny nor confirm if it's true.

Regards,

Tina, CPC-A
 

kibbit99

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PT only uses 97001 if new patient/new dx-this is considered evaluation
OT only uses 97003 if new patinet/nex dx-this is considered evaluation
re-evals get done every four weeks for Medicare/W/comp and the codes are as follows:

PT 97002
PT 97004

Hope this helps!
 

krssy70

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97002

Do you have anything in writing on the 97002 that states you can only bill the re-eval every 4 weeks? Our physical therapist is billing 97001 for the intial evaluation, but we are unsure on the guidelines for the 97002. Anything will be a big help....

Thank you,
Kristen Richard, CPC
 

pammalou

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Go to the wpsmedicare site and search for the PT policy, this is loaded with information. It is Medicare, but more companies are following their rules. Also, Medica and United Healthcare I have found to have great resources for policies. I do billing for Medical, Physical therapy and Chiropractic in our office and PT's do NOT bill any E&M, the 97001 (eval) and 97002 (re-eval) are their version of an E&M.
 

krssy70

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Can you please send me the link. I am from Rhode Island and we use NHIC. Not sure what wpsmedicare website is. Also, I did pull some info on the CMS website, and for the 97002, it does not state anything about 4 weeks. I am just wondering how to utilize the 97002 and when we are able to bill for that.
 
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