Wiki Physical Therapy Billing

[mariadifuccia]

Can we bill an E&M with an initial PT evaluation? Medicare will not pay 97001 alone unless it is billed with an E&M. The providers are not seperatly performing an E&M so it would be innapropriate to code w/ a modifier 25. Does anyone have any insight? Thank you

 

[coding4fun]

Physical Therapy

97001 is strictly used for PT EVAL (not timed) and typically is not billed in conjunction with an OV. Please review your claim form to make sure that your dx codes are carrier applicable. If you need any further assistance, please feel free to ask as I worked for rehab for over 2 years.

Happy Coding!

 

[MarcusM]

A physical therapy evaluation is conducted by a physical therapist who checks the patient's joint flexibility, muscle strength, gait, mobility, and neuromuscular function.

Clinical Responsibility
The physical therapist (PT) performs a general overall evaluation of the patient. The PT takes a brief medical history followed by an analysis of the patient's muscle strength, flexibility, balance, coordination, gross neuromuscular status and mobility. The PT also reviews the condition of any prosthetic device, if present. The patient may be asked to perform a variety of movements throughout this evaluation. The entire procedure usually takes approximately 30 minutes. Finally the PT summarizes their clinical findings in the Assessment and Planning section of the SOAP note section of the evaluation sheet. The PT also may discuss the diagnosis and possible physical therapy intervention and its benefits with the patient.

E&M is mutually exclusive with PT eval so denial must be diagnosis related like noted above. Check the LCD for more information.