Wiki Physician and PT billing

[giliwjoy]

Please let me know the right way to do the billing. Family physician saw patient for cough, hypertension and Shoulder pain. Family physician billed for 99213 and referred pt for physical therapy and Physical therapist billed for 97140 2 modalities (2 units) with dx code of shoulder pain. Physical therapy code got denied. What is the right way of billing? Please advise

 

[gr8gal61]

Please let me know the right way to do the billing. Family physician saw patient for cough, hypertension and Shoulder pain. Family physician billed for 99213 and referred pt for physical therapy and Physical therapist billed for 97140 2 modalities (2 units) with dx code of shoulder pain. Physical therapy code got denied. What is the right way of billing? Please advise

9140 with modifier GP for the PT

 

[giliwjoy]

Physician and PT Billing

What about the dx codes. should I put all the dx codes under E/M code including shoulder pain or not?

 

[mitchellde]

Is the PT in the same tax ID as provider?

 

[giliwjoy]

Yes, they are all in 1 tax id no. Medicare is the one who is denying one code. Thank you.

 

[teresabug]

you need to append a 59 modifier on the physical therapy services.

 

[mitchellde]

Many payers will consider the PT inclusive to the E&M when performed on the same day in the same office. A 59 may not help in this scenario. I have run into this with Medicare and no modifier will cure it. Apparently it is stated in the Medicare manual. So they have informed me!

 

[giliwjoy]

Physician and PT Billing

As far as I'm concern, United, Aetna and BCBS have been paying these claims except for Medicare. Somebody told me that the way it should be billed it is:
Example: Patient came to the office with hypentension, cough and shoulder pain. 1. E/M code - with the dx code of hypentension, and cough then put a modifier of 25, then 2. Physical Therapy code with dx of shoulder pain. Do you think this should work? or not. Please advise. Thank you.