Question PT re evals

mnuhfer04

Networker
Messages
37
Location
North Tonawanda, NY
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Hey all! I used to be able to bill a pt eval 97164 w/mod 59 and then also bill therapeutic exercise (97530) and get paid for both. Recently I have been getting paid only for the 97530 and denied the re eval stating "NCCI Denial for Column1/Column II Procedures with Claim Validation". I've tried looking up the NCCI edits to see if something changed where we can't bill both on the same day, but I didn't find anything (unless I missed it). Anyone have an input on this? Thanks!
 

leagle

New
Messages
8
Location
Ishpeming, MI
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Still should be payable...what insurance is it? Humana is notorious for denying even with the 59 because they want medical records to verify billing is compliant. It's almost like they think the 59 is the next 25 with overuse and misuse....I'd check with the insurance and see if it they would review and reconsider w/ notes.
 

mnuhfer04

Networker
Messages
37
Location
North Tonawanda, NY
Best answers
0
Still should be payable...what insurance is it? Humana is notorious for denying even with the 59 because they want medical records to verify billing is compliant. It's almost like they think the 59 is the next 25 with overuse and misuse....I'd check with the insurance and see if it they would review and reconsider w/ note
The insurance is Fidelis (in NY). I will be giving them a call, its so frustrating, thanks your response!
 
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