Michele1229
Networker
Hello Everyone -
We need some help in my office. We deal with workers compensation. We have a bill for a provider who is billing 64445 and 97535. In the ncci edits there is an edit for the code pair 97535 64445 which is a 1. The provider is putting the 59 modifier on the block code. What should we see in documentation to support paying the 64445 separately from the OMT/PT billed? We saw one place state that the OMT/PT needed to be performed on a separate muscle than the block to justify payment of both.
Any guidance is appreciated!
Thanks
We need some help in my office. We deal with workers compensation. We have a bill for a provider who is billing 64445 and 97535. In the ncci edits there is an edit for the code pair 97535 64445 which is a 1. The provider is putting the 59 modifier on the block code. What should we see in documentation to support paying the 64445 separately from the OMT/PT billed? We saw one place state that the OMT/PT needed to be performed on a separate muscle than the block to justify payment of both.
Any guidance is appreciated!
Thanks