Wiki Physical Therapy - insurance company

[tlewis76]

Hello

Please help me. I have a denial for physical therapy because we charged 97002 pt re evaluation and 97110 therapeutic exercises and we are getting a denial because they are unbundled. The insurance company would like for us to bundled the services. Please help why can we not charge both on the same day? Is there away around this?

Thanks
Tawiana

 

[mitchellde]

The 59 modifier is appropriate ONLY if the re-eval and the therapeutic exercise are for two different reasons, such as different diagnosis or different area of the body. If this is not the case then you may not bill both together and you should definitely not unbundle with the 59 as your documentation will not support it.

 

[anuja.devasthali]

Is the same criteria applicable for denial of CPT 97110 when billed with CPT 97113 ?