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Thread: Ortho/Physical Therapy Help!!!

  1. #1
    Join Date
    Apr 2007

    Smile Ortho/Physical Therapy Help!!!

    AAPC: Back to School
    I code for an ortho group that is now doing physical therapy. I have an issue where a patient was referred to PT and had a few sessions before the decision for surgery was made, (first session was billed out with 97001) for torn labrum. My question is, one month later the Physical Therapist is wanting to bill for another initial evaluation(97001). Im thinking it would be the re-evaluation (97002) based on the fact that it is still relating to the shoulder, no other new problem. Which is correct?

    Any help is greatly appreciated


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If the patient had surgery and is here now for rehab after surgery then it is for a different issue the entire PT program will be different. The dx codes will be different as well. You will use the V57.1 as the first listed and then the reason for rehab such as stiffness or muscle weakness but not a torn labrum if it was surgically corrected.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Depending on the insurance, you may be not able to bill another 97001 - some have time spans for this code.

  4. #4
    Join Date
    Apr 2007
    Chattanooga, TN

    Default therapy

    The best practice for the clinician is to discharge the first case prior to the surgery. Start a new case with the new dx as the tear was repaired and the Clinician will develop a new plan of care with a new eval. there are some payors which limit the # of evals. Most therapists do not want to complete the discharge note due the "extra" documentation. most practice acts require discharge notes as well.

  5. #5
    Join Date
    Apr 2007


    Thank you all so much for the responses!!

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