Wiki PT and E/M


True Blue
Overland Park, KS
Best answers
If a physician evaluates a patient for lets say shoulder pain and then performs PT on the patient, would you bill an E/M for the evaluation or use the PT evaluation code? If you use an E/M would you also append modifier 25?

Good afternoon!

By your question, I am not clear regarding the PT? Is the patient in PT for their shoulder? If they are in therapy for their shoulder and the physician performs an evaluation on that should then starts therapy during the same day, s/he would report 97001 for the Assessment, then 971** x X for each 15 minute increment in therapy.

However, if the shoulder is completely separate from the reason for the PT, then yes, they would report the E/M 9921* for established patient visit, then the 971**-25 x X units for each 15 minutes in therapy. The modifier is attached to the procedure or service, never the E/M.

I hope that you find this response helpful.

Sorry for the delay, I wasn't notified about your follow-up call. Here's what Ingenix EncoderPro shows:

(This modifier is only reported when the service is performed as a part of the therapy plan of care. These services are "sometimes therapy" codes that can be performed by non-therapists. Report this modifier only when a qualified therapist performs the service. If a non-therapist performs the service do not report this modifier.)

I also found this article from April 2010 that I think you'll find useful.

Mary Corkins