Wiki Physical Therapy Codes/MOD 59

[bertrandr]

Help!

I have had issues with payers denying MOD 59 when billed for paraffin baths (97018) for same extremity, (ex. hand and fingers) on the same date of service. I billed with one unit but it was still denied when I used the MOD 59. I cannot find any information that states that this type of service can be billed with MOD 59.

Any help you can give me would be really appreciated.

Thanks
Rhonda

 

[mhstrauss]

Help!

I have had issues with payers denying MOD 59 when billed for paraffin baths (97018) for same extremity, (ex. hand and fingers) on the same date of service. I billed with one unit but it was still denied when I used the MOD 59. I cannot find any information that states that this type of service can be billed with MOD 59.

Any help you can give me would be really appreciated.

Thanks
Rhonda

Are you asking about billing multiple units of 97018 on one DOS? Or billing 97018 with other CPT codes on the same DOS?

 

[honeybee]

If you are trying to bill more than 1 unit of 97108 per DOS it is considered an untimed code so only 1 unit is eligible for payment regardless if it was provided to more than 1 part of the body or if more than 15 mins was spent and it cant be paid even with the 59 mod (this applies to any of the modalities or therapy codes that start with 970XX). If this is not the issue, what other codes are you billing on the claim? You should be able to refer to the NCCI edit chart on the CMS website to reference what other codes are bundled to 97018.

Missy Lupercio
CPC-A
Spooner Physical Therapy