Can a physical therapist bill and E&M level services code ? I was always thought that PT/OT/ST should only use CPT code 97000's. But I have been told that they can bill E&M level code's since in the coding book it says other qualified health care professionals can someone please give me some insight.
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Wiki Physical Therapy - E&M level
- Thread starter DJKRONUS
- Start date
ecaissie
Guest
I was exploring doing some billing for a speech therapist about two years ago, and she said she had billed E&M codes for speech therapy before and had gotten paid; however, I did not do any billing for her and cannot verify that. I've billed for a physical therapist in the past and he did not; any therapist I've spoken to was leery of doing it, claiming that if you do get paid, the payer may wind up recouping the funds at a later date.
mitchellde
True Blue
While you MIGHT be able to use visit levels, you cannot substitute visit levels for CPT codes that are applicable for the service rendered. Therefore for what type of encounter would a therapist need to use visit levels?
ecaissie
Guest
From what the speech therapist told me, she had been billing both 99211 and a CPT code, such as 92506. I wasn't sure that was OK, but when I looked it up, I came up with the same quote as the original poster to this thread did. The thing that concerned me what she was not doing a complete history or examination. So I was going to try it and see what happened, but as it turned out I could not get her software to work (they had not updated to Version 5010 properly, I think) and I never did any billing for her.
mitchellde
True Blue
There would not be a valid reason for charging a 99211 and a PT code. There is nothing significant that could be performed in addition to the PT. The PT is a scheduled encounter. A physician office cannot bill this way either.
So let me make sure I am correct in understanding what you are saying that PT/OT/ST should not have a valid reason for charging for and E&M level charge? I was told the reason they use 99201 if for FAMILY/PATIENT EDUCATION (15MIN) seeing non of the 97000's code really apply.
mitchellde
True Blue
a code for education and training for patient self management might work hewre, 98960, but to charge a visit and a PT code for a scheduled PT visit , wouyld be incorrect. the patient training woulod be considered a part of the modality I am thinking. Also the documentation would need to suppport that this education and training is significantly different than the therapy, and it most likely is not.
If the patient is receiving no PT during the encounter then depending on the documentatio0n I might see that a visit level is appropriate.
If the patient is receiving no PT during the encounter then depending on the documentatio0n I might see that a visit level is appropriate.
mitchellde
True Blue
I would say that looks like a 98960