Wiki Physical therapy question- 97760 with 97140/97110

[priceless]

Hi
Our OT is billing 97760 with 97140 and 97110 for a upper extremity. Orthosis management, therapeutic exercise /manual therapy are all documented.
But these codes have a NCCI edit with modifier allowed. My understanding is modifier 59 can be used only if different body part.
But I found this excerpt in CMS policy, page 25.
https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-11.pdf

"Some NCCI PTP edits pair a “timed” CPT code with another “timed” CPT code or a non-timed CPT code. These edits may be bypassed with modifier 59 or XU if the 2 procedures of a code pair edit are performed in different timed intervals even if sequential during the same patient encounter"

Since 97760 and 97140 are timed codes, would a 59 be allowed if done in different blocks?
Am I interpreting this correct?
Thanks

 

[Deborah Marsh]

Hi - I'm not familiar with the specialty, but in general there are various situations that can support mod 59 (e.g., separate session, procedure, site). I agree with your reasoning on coding separately when done in different time blocks. It's always great to find support in the NCCI manual! This may be a useful resource, too (though not authoritative): https://www.apta.org/your-practice/payment/coding-billing/correct-coding-initiative-cci

It includes a link to a decision tree: https://www.apta.org/contentassets/...ding-initiative-decision-tree-59-modifier.pdf