Wiki Same Day- OT, PT, ST Modifier

cincin0713

Guest
Messages
9
Location
San Antonio, TX
Best answers
0
I just started to receive denials from Superior Medicaid regarding incorrect use of modifier per CMS/CPT/Plan guidelines. It looks like the biller appended a 59 modifier on our OT treatment visit since patient also had an ST treatment visit done the same day. Should we be using the 59 in these situations? Or can we bill them as is since the ST treatment CPT is an untimed code? Thanks in advance!
 
Hi
Does OT mean occupational therapy? I would use the laterality modifiers (RT or LT ) according to physical therapy done on each limb or arm or leg or foot or hand. Also use the dx codes of pain for each limb too look at dx blocks of M79 or M25. Also use the modifier of GO if physician is doing the manipulation massage or hot pack treatments. If a phys therapist is doing PT treatment use modifier GN. Have you tried modifier 51..multiple places? But check with the payers first. Also you may need a referral doc listed on claim who wants the pt. to get OT or PT. Check out modifier 27 for outpatient done at 2 differ sites on same day.
I hope this data helps you.
Lady T:)
 
the 59 modifier would not apply in this situation. If the patient is seeing two different therapist for two different conditions and the SP and GO modifier attached to each claim does not work the best option is too appeal (which I know with Medicaid is a long shot) but insurance companies are starting to red flag the 59 modifier for PT/OT and SP. Make sure the GO services and being billed on a separate claim from the SP services!
 
The 59 modifier is only appropriate for the same code on the same day by the same provider.

* The MUE values and NCCI PTP edits are based on services provided by the same physician to the same beneficiary on the same date of service. I-8 https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare Chapter 1

If your PT billed 97530-GP (GP is the modifier for Physical Therapy) and your OT billed 97530-GO (GO is the modifier for Occupational Therapy) on the same patient on the same day, then modifier 59 would be appropriate for one of the codes. There is an NCCI edit between 97530 and 92507 but ONLY if the services are provided by the same provider/therapist. And all your therapies should be billed on separate claims. Is it possible to submit a corrected claim?
 
Top