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Coding for CPT 97140 & CPT 97035

  1. Smile Coding for CPT 97140 & CPT 97035
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    Hi Friends,

    Can anyone help with this ?

    Our Internal medicine provider perfomed CPT 97140 & CPT 97035 at office for Medicare patient.
    Medicare denied two procdures as modifier is required.
    We have submitted claim with adding 59 modifier. But again claim got denied stating Invalid Procedure & Modifier combination.

    What we suppose to do in this case ?
    Is there any other modifier available ?
    or
    Is there any other CPT code that should in place of CPT 97140 & CPT 97035.

    Thanks.
    Neha Bhatnagar, CPC, CPC-H.

  2. #2
    Red face Call
    There is no bundling issue with these two codes, I would just call Medicare and ask what they want. Sorry if it wasn't much help, but I would like to know what they have to say if you do call.
    Diana. CPC

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Perhaps they are looking for modifier KX since these are PT services...?
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Default Careful while listing modifier KX
    Careful while listing modifier KX......

    Nidhi M

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I agree...it was just a thought.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
    Denver Colorado
    Posts
    279
    Default
    Both 97140 and 97035 are considered "Always therapy" codes by Medicare and require one of the modifiers indicating that the service was provided under a therapy plan of care regardless of who provided the service. For physical therapy, the modifier if -GP.

    Here is the link to the Medicare transmittal with the information: http://www.cms.hhs.gov/manuals/downloads/clm104c05.pdf with this information starting on page 29

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