Physical Therapy- billing eval/re-eval on same day as other procedures?

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I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same session, and I'm hoping someone can help.
Examples:
97162 and 97530-59 : only 97530 was paid (Alaska Medicaid). 97162 denied for bundling.
97164, 97140 and 97110 : only 97140 and 97110 were paid (Premera BCBS), eval denied for bundling.

Is it inappropriate to bill for therapeutic codes on same day as eval? The code descriptions seem to allow it, and I can't find coding conventions preventing it, but I just can't get paid.
Any help you can give would be appreciated.
 

mnuhfer04

Networker
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Location
North Tonawanda, NY
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I've been having a really hard time getting my physical therapy evaluations paid when any other form of therapy was provided during the same session, and I'm hoping someone can help.
Examples:
97162 and 97530-59 : only 97530 was paid (Alaska Medicaid). 97162 denied for bundling.
97164, 97140 and 97110 : only 97140 and 97110 were paid (Premera BCBS), eval denied for bundling.

Is it inappropriate to bill for therapeutic codes on same day as eval? The code descriptions seem to allow it, and I can't find coding conventions preventing it, but I just can't get paid.
Any help you can give would be appreciated.
Hi Lexy, I am still a new coder/biller, but I was told by one of our commercial insurance reps that you cannot bill for any other service when an eval is being billed...they did say that it was bundling. I have been trying to get more information on the subject so that I am 100% certain.
 

leagle

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Ishpeming, MI
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So at the beginning of 2020, Medicare had the brilliant idea to say that you couldn't bill 97530 with ANY eval code AT ALL - no modifier allowed. They repealed that decision after everyone threw a fit, but I do know that some payers stuck with the rule. What was the DOS? I'd contact Medicaid and verify whether they follow Medicare's PTP edits or not and have them look into this...should be payable if they follow suit with Medicare. On the 2nd one, the 97164 requires a 59. If you check out the PTP edits, that code always requires one when billed with any tx on the same day.
 
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