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PT Cost and 99211 troubles

  1. Default PT Cost and 99211 troubles
    Medical Coding Books
    I work for a doctor's office who does PT's in house. They recently discovered that just doing the PT was not going to provide any income, in fact they were losing money on each test. To counter act this they decided to make every PT a face to face encounter and do a quick overview of the patients past history. In doing this they felt they could easily file a 99211. Since a procedure, a PT (85610), was done during the office visit medicare will not pay for a 99211, they will however pay for a 99212. Is there anyway to make a 99211 work with a PT.


    Is there any additional items we can add to the PT so that the practice will be able to make money on a PT.

    If this is unable to be resolved the practice will have to stop doing PTs in house.

  2. #2
    Columbia, MO
    If the patient is scheduled to come in for a lab draw you can charge only the 36415 or 36416 and the 85610, not a 99211. Fro a 99212 the physician must see the pt face to face and document enough to meet the 2 out of 3 key components.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    In addition to what Debra said you also have to have medical necessity. Documenting enough to bill a 99212 just so they won't lose money is not going to support medical necessity.

    Sounds like they will have to stop doing them in office or decide it is worth the financial hit and just take the loss.

    Laura, CPC, CEMC

  4. Default 99211 & pt
    I have been doing research lately on 99211. Check out the medicare website and put in 99211 and this exact delima will come up in your search results. That way you will have real documentation to provide to your physician.

    99211 can be billed with PT if there is a medication change according to Medicare guidelines. I would discourage your physicians from using 99212 unless it is "Medically necessary" which as the other postings suggest would need to meet the specific criteria. But if a physician is trying to get to a certain level it is not a good sign. Patient care should be #1, then reporting the accurate code to reflect the level of care should be #2 not the other way around. In my humble opinion.

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