awolf214
New
Good morning,
Our PT location has seen an increase in denials from payers ranging from Aetna Commerical, Anthem Commerical, Anthem Medicaid, MHS, Humana Medicaid and Humana Medicare denying code 97012 when billed with 97140 stating "Mutually exclusive procedures cannot be done in the same day/setting". Our PT Director advised their practice is to add Mod XU to 97140 when these codes are billed on the same day. Is the preference modifier 59 in this scenario? They steered away from 59 because XU was more specific. Curious if anyone else is seeing these trending denials or how you guys are getting reimbursement on these codes? We are located in Indiana. Any guidance is much appreciated as I am unfamiliar with PT coding.
Thank you
Our PT location has seen an increase in denials from payers ranging from Aetna Commerical, Anthem Commerical, Anthem Medicaid, MHS, Humana Medicaid and Humana Medicare denying code 97012 when billed with 97140 stating "Mutually exclusive procedures cannot be done in the same day/setting". Our PT Director advised their practice is to add Mod XU to 97140 when these codes are billed on the same day. Is the preference modifier 59 in this scenario? They steered away from 59 because XU was more specific. Curious if anyone else is seeing these trending denials or how you guys are getting reimbursement on these codes? We are located in Indiana. Any guidance is much appreciated as I am unfamiliar with PT coding.
Thank you