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help with occupational therapy billing and the correct use of modifiers

  1. #1
    Exclamation help with occupational therapy billing and the correct use of modifiers
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    I am doing a billing internship for an outpatient rehabilitatation clinic. I bill for an OT and a PT .We also do community based care in the public schools and patients homes from time to time. I want to make sure that these CPT code and modifier combinations are acceptable for the same patient on the same date of service. 97003 and modifier GO, 97110- GO-59, and 97112-GO-59? Any assistance would be a great help!
    Last edited by cthompson1446; 04-12-2010 at 11:33 AM.

  2. Default
    You do not need to use modifier 59 when performing an eval and neuro re-ed. They are already distinct procedures. If the patient has therapeutic exerise in addition to aquatic therapy on the same day, you would bill 97110 and 97113-59 to signify that two distinct therapeutic exercises were done that day. Other than that, you will rarely need to use modifier 59 for therapeutic procedures as they are already distinct procedures.

  3. #3
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    Thanks Would I need to use modifier 51? to indicate that multiple theraputic procedures were done in the same day/visit?

  4. Default
    No, you do not need to use the modifier 51. You would just use the number of units performed. For instance, you would bill you OT eval as 97003-GO and the neuro re-ed as 97112-GO with the number of units that correspond to each 15 minutes the OT spent doing the neuro re-ed. If they also did manual therapy on that day you would bill 97140-GO with the number of units (15 minutes) spent. For most OT and PT visits you will have more than one type of service and/or modality performed at each visit. You do not need to use modifier 51 for these. Also, keep in mind that you do not need the modifier GO for OT or GP for PT on private insurance claims. If you need additional help, you can email me directly at kcbuck11@yahoo.com.
    Cara Buckhaulter, CPC

  5. #5
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    Hi Cara,
    I have 2 patients that have humana medicare insurance.. Do I need to append modifier GO and GP to the cpt codes? Or is humana considered a private insurance even though it is a humana medicare policy? Your assistance is greatly appreicated!
    Christina

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