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Please help Physical Therapy Coding

  1. #1
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    St.Louis East Chapter
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    Default Please help Physical Therapy Coding
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    Hello I have started a new job with a university and they have an office for Student Health and they currently put in charges for physical therapy this is my first experience with physical therapy. My question is why are we getting an edit when using 97002 and 97110. Should there be a modifier with this when submitting this charge or should it be something different we should be coding. The physical therapist is currently trying to bill both for one patient. Please help

  2. #2
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    Columbia, MO
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    It is my understanding that unless the re-eval was for a different reason than the exercises then you cannot bill both on the same day. You can use a modifier IF the re-eval was for a different dx than the exercise is for. Also remember your first listed dx code is V57.1 if the reason for the encounter is rehab.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Phoenix, AZ
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    You need to always add modifier -59 when billing 97001 and 97002 with any other modality.

    Good luck,
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  4. #4
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    Phoenix, AZ
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    Debra,

    Why would the first code be V57.1? In 13+ years of billing PT/OT, I have never used that code.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  5. #5
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    Columbia, MO
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    Quote Originally Posted by Cyndi113 View Post
    You need to always add modifier -59 when billing 97001 and 97002 with any other modality.

    Good luck,
    Yes but only when there is a different reason for the eval from the modality. Such as an eval for the shoulder but a modality for the hip then the 59 modifier is appropriate. It is incorrect to just add a modifier because there is an edit. We add a modifier because we have a reason to split the two services apart. Sorry but I really thought I should clarify this.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Columbia, MO
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    Quote Originally Posted by Cyndi113 View Post
    Debra,

    Why would the first code be V57.1? In 13+ years of billing PT/OT, I have never used that code.
    Since about 1980 the guidelines have specified that when the reason for the encounter is for rehab then the V57.xx code must be the first listed code, then in 2003 they re designated the V57 codes as first only allowed. This is on page 12 number 15 of the guideline set. I know many have never coded this way and to be honest many claims have not been paid correctly as a result. OT has a different V57.x code but PT is V57.1.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Phoenix, AZ
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    Hmmm, that's really news to me. I worked for a PT/OT/MT company until 2007 for which we billed for 20+ clinics. We never used those codes. Our claims were actually denied if we used V or E codes.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  8. #8
    Location
    Columbia, MO
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    That is a common myth with V codes, they are perfectly fine when use according to the rule. SOme V codes are never allowed first and some are only allowed first. E codes are never allowed first. The reason for a denial when using a V code first is either that you used a second only allowed V code first or the patient has no benefits for that service. The guidelines that been set forth by the CDC will tell you that these guidelines are a set of rules and adherance to thes rule is required under HIPAA. I know a lot of rehab services do not use these codes and it is due to the myth surrounding V codes. Not because it is correct. I know that this is not popular and will cause problems when you go to change this in your office, which quite frankly may keep you from using them even still. I can only point out that this is the correct way to code and if a payer does not pay with the V code first listed it will be because the patient did not have benefits for that service.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    Can you please provide a link to the documeentation stating it is appropraite to bill the V code as primary. I to was under the impression that using the V code primary was appropriate coding. However our multi-specialty clinic is adding a PT/OT clinic and I was unable to support the V code useage. Below is the information on coding as provided in our lacal MAC's (WPS) policy on "Outpatient rehab services billed to Medicare Part B".
    As you can see the information they provide conflicts with the use of V57.1 or V57.21 as primary. I would like to get this correct before we start billing our services. Additionally, Do you use the GO/GP modifier for all payers or just Medicare? This also is a source of conflict in our office.

    a. Report the patient's specific condition for which the current therapy episode of care services is being performed in the first position in Item 21 of the CMS1500 claim form or electronic format equivalent field.

    b. Report existing conditions, complexities, or circumstances influencing the length or intensity of the current therapy episode of care in the remaining positions.

  10. #10
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    The Guidelines as updated Oct 1 2010:
    http://www.cdc.gov/nchs/icd/icd9cm_a...guidelines.htm
    State:
    Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings.
    On page 12:
    15. Admissions/Encounters for Rehabilitation
    When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis.
    Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed.

    Debra A. Mitchell, MSPH, CPC-H

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