Wiki Physical Therapy Office Setting Billed Professionally

Messages
1
Location
Costa Mesa, CA
Best answers
0
Good evening fellow coders! I recently accepted my first coding job in a physical therapy clinic. I am searching for some great resources on modifiers and how/when to use them appropriately with the physical therapy code set. We are using 97161-97163 for evals and codes 97010-97535 for exercises, etc. I see a lot of the 59 modifier as well as GP and KX for medicare. The typical bill would could include any combination of the 97110, 97112, 97140 and 97535, including multiples of them. What needs the 59 modifier and when is it appropriate? Also, should we be using the XS modifier sometimes as well instead of the 59? Any guidance or resource links appreciated!
 
Hi there Unique00madness!!:)
Ok here are some tips might help.....the CPT codes are correct, should be documented minutes and body location of OT or differ PT medical treatments used. Add the modifiers of GN GO GP according to specific treatment. I d use the modifier 59 if differ places on body leg vs arm or differ types of therapeutic treatments during same date and session. Modifiers XE, XP, XS, and XU are intended to bypass a CCI edit by denoting a distinct encounter, anatomical structure, practitioner, or unusual service. However, even though these modifiers use maybe governed by the payer's regulations. CPT 97140 (manual therapy techniques like mobilization/manipulation, manual lymphatic drainage, or manual traction on one or more regions,) each for 15 minutes documented. According to NCCI in July 2021, the following are considered linked services when billed in combination with 97140: 95851, 95852, 97018, and 97550. So, if you bill any of these codes with 97140, you’ll receive payment for only 97140. CMS states that when billing 97140 and any of its pairs for the same session or date, modifier 59 is only appropriate if the therapist performs the two procedures in distinctly different 15-minute intervals. This means that you cannot report the two codes together if you performed them during the same 15-minute time interval. It’s important to note that you can never bill 96523 or 97124 with 97140, because these codes represent mutually exclusive procedures.
I do know their some interesting PT diagnostic codes can check out dx X50 or add the reasons and the date if external injury. Also if the doc adds chronic pain in documentation, ensure put that dx code G89.29 AFTER the area aching with pain such as: leg arm , hand, ankle joint from dx. blocks M25 and M79. Also might add dx R29.89 if it medical record warrants Also there are dx codes of specific muscle stiffness, muscle effusion, sprains vs spasms, add these dx if appropriate. Then there is dx Z71. 82 for exercise counseling if patient received this data during treatment
Well hope this data helped you
Lady T(y)
 
Top