Wiki PT questions


St Helena Island, SC
Best answers
Our office has just started OT services. I have a few questions about billing.

In a therapy setting, when is it appropriate to use the 59 modifier?
When billing incident to, Can a patient be seen by the physician and have therapy on the same day?
When is it appropriate to use the group therapy charge CPT 97150?

Thank you in advance for any feedback.

Tammy B.,CPC
The 59 modifier is used is most commonly anytime you do both manual therapy (97140) and traction (97012) in the same visit (put the modifier on the manual charge). I work in a PT office and when we bill for PT re-evaluations (97002) and either theraputic exercise (97110), manual therapy (97140), or self-care management (97535) we have to add the 59 modifier to the non-eval charges. But I don't know if that applies to OT re-evaluations.

Yes, you can bill physician services on the same day as therapy. Depending on the insurance, the patient may have to pay 2 copays though.

As far as when to bill 97150, there was an article in this month's Coding Edge with the guidelines. The article was discussing its use in a chiropractor's office, but the guidelines still apply to all providers.

Hope this helps!