Wiki PT billing

[shamkok1]

Hello

I came across the hurdle which I can best clear with your expert help.

I have to create clean claim with Physical Therapist's 1st visit for PT evaluation (97162) and the procedures (97110) (97112) and (97140) on the same day by the same therapist.
How do I create the claim and which particular modifiers should go with the particular CPT codes in order to submit the clean claim?

Appreciated your help!!

 

[SharonCollachi]

Perhaps it would be helpful if you tell us what you think it should be first, and your reasoning. And explain what you mean by "how do I create the claim".

 

[shamkok1]

Hello Ms "SharonCollachi"
as per my point of view I would put 97162 with modifier 59 or 25 confused for those two and than GP
whereas for the rest of the codes such as 97110, 97112 and 97140 I just put GP modifier.
But this is what I think and I don't know whether am I thinking correctly?

So need help in that regard Ms "SharonCollachi"

 

[Brooklynn1]

All PT CPT codes should have GP modifier along with start and stop time for Physical therapy total time.
For Example: PT evaluation note
Start : 10:am to 11am total time 60 min.
Eval : 97162-GP (30MIN) ,97110-GP(10MIN) 97112-GP(10 MIN) and 97140-GP(10MIN) TOTAL TIME 60 MIN.
Besides eval 97162 all other CPT's must state the type of therapy provided plus long or short term goals.

 

[shamkok1]

All PT CPT codes should have GP modifier along with start and stop time for Physical therapy total time.
For Example: PT evaluation note
Start : 10:am to 11am total time 60 min.
Eval : 97162-GP (30MIN) ,97110-GP(10MIN) 97112-GP(10 MIN) and 97140-GP(10MIN) TOTAL TIME 60 MIN.
Besides eval 97162 all other CPT's must state the type of therapy provided plus long or short term goals.

That great. Thanks for the answer but still I am unclear for the modifier and it’s placement where it goes and which one other than GP. Because if you do eval and therapy same date and time I feel there must be some modifier which I exactly don’t know to put it with particular CPT code !!!???

 

[debbie.denson74]

That great. Thanks for the answer but still I am unclear for the modifier and it’s placement where it goes and which one other than GP. Because if you do eval and therapy same date and time I feel there must be some modifier which I exactly don’t know to put it with particular CPT code !!!???

GP will go on all codes, and depending on the date of service and payor you will need to add modifier -59 to 97140. CMS released an update to the PTP edits on 4/8/2020 that they have deleted the PTP edit and 97140 is no longer a column two code for 97162. this is retro active to 3/6/2020. Therefore if you are billing Medicare or any payor that follows CMS edits, then you do no need to apply the -59 modifier to 97140. But if they do not follow Medicare then you will need to add -59 modifier to 97140 since they are considering it a column two code.