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Physical Therapy modifiers

  1. #1
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Default Physical Therapy modifiers
    Medical Coding Books
    PT coders: does anyone know how to code 97110, 97113, & 97530 on same bill? I know mod 59 gets attached to 97530, but I don't know which other code gets a mod. I'm also having a problem billing 97124 with 97140. Help is appreciated; need to get these claims OUT.
    Thanks!!

  2. Default
    All of your codes should have mod GP.

    What kind a rej are you getting for 97124/97140?


  3. #3
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Default
    It's Mdcr, so I did apply GP to all codes, but on the one claim, the claim scrubber is stating the following:
    Trigger Procedure 97140 on Visit #228035, Line #3 and Target Procedure 97124 on Visit #228035, Line #2 are Unbundled and the TARGET is inappropriate. The Standard Policy Statement reads "Standards of medical / surgical practice".
    On the other claim:
    Trigger Procedure 97530 on Visit #226677, Line #2 and Target Procedure 97113 on Visit #226677, Line #1 are Unbundled and the Target is inappropriate. The Standard Policy Statement reads "More extensive procedure".
    Does this make sense to you??

  4. Default
    So, these have not been billed out yet?

  5. #5
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Default
    No. Trying to get it right the 1st time out. My employer frowns on denials.

  6. #6
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Default
    Do you understand those msgs? I thought I did at 1st, but every combination I've tried, doesn't fly.

  7. Default
    FYI - I am not a coder (cert. in medical billing). I have no idea what they are talking about.

    This is what I found on HAPs website - clear claim connection:


    Click on recommendation of "Disallow" or "Review" to obtain clinical edit clarification.

    Line Procedure Description Mod 1 Mod 2 Quantity Date of Service Place of Service Payment RVU Pay % Recommend

    1 97140 MANUAL THERAPY 1.00 8/1/2011 11 (Office) n/a 0 Allow
    2 97124 MASSAGE THERAPY 59 1.00 8/1/2011 11 (Office) n/a 0 Disallow
    3 97530 THERAPEUTIC ACTIVITIES 59 1.00 8/1/2011 11 (Office) n/a 0 Allow
    4 97113 AQUATIC THERAPY/EXERCISES 59 1.00 8/1/2011 11 (Office) n/a 0 Allow

    Per HAP - 97124 is included w/ 97140

    Inquiry:
    Why is this procedure disallowed?
    Procedure Description
    97124 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION)
    97140 MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), 1 OR MORE REGIONS, EACH 15 MINUTES

    Response:
    HCPCS/CPT codes define procedures include services that are integral. Integral services have CPT codes for reporting service when not performed as an integral part of another procedure. Services integral to HCPCS/CPT code are procedures included in services based on standards of medical/surgical practice. It is inappropriate to report services alone that are integral to another procedure.NCCI edits are based on standards of medical/surgical practice. Services that are integral to another become component parts of comprehensive service. Integral component services have their own HCPCS/CPT codes, NCCI edits place comprehensive service in column one and component service in column two. A component service integral to comprehensive service is not separately reportable; column two codes can not be reported separately with column one code.Services are integral to large numbers of procedures. Other services are integral to a limited number of procedures. Examples of large number of procedures include:" Cleansing, shaving and prepping of skin" Draping and positioning" Insertion of intravenous access for medication administration" Insertion of urinary catheter" Sedative administration by physician performing procedure (Chapter II, Anesthesia Services)" Local, topical or regional anesthesia administered by physician performing procedure" Surgical approach including identification of anatomical landmarks, incision, evaluation of surgical field, debridement of traumatized tissue, lysis of adhesions, isolation of structures limiting access to surgical field such as bone, blood vessels, nerve, muscles including stimulation for identification or monitoring" Surgical cultures" Wound irrigation" Insertion/removal of drains, suction devices, pumps into same site" Surgical closure and dressings" Application, management, and removal of postoperative dressings and analgesic devices (peri-incisional" TENS unit" Institution of Patient Controlled Anesthesia" Preoperative, intraoperative and postoperative documentation, including photographs, drawings, dictation, or transcription necessary to document services provided" Surgical supplies, for specific situations where CMS policy permits separate paymentChapters in Manual address issues related to standards of medical/surgical practice for procedures covered. It is not possible because of space limitations to discuss all NCCI edits based on principle of standards of medical/surgical practice. There are general principles that can be applied to edits as follows:" Component service is accepted standard of care when performing comprehensive service." Component service usually necessary to complete comprehensive service." Component service is not separate procedure when performed with comprehensive service.
    Therefore, this procedure is not recommended for separate reimbursement.


    Now this is what I found on BC's web site clear claim connection:

    Claim Audit Results


    --------------------------------------------------------------------------------



    Gender: Date of Birth:


    Recommend Procedure Date of Service Description Modifiers
    Allow 97113 08/09/2011 AQUATIC THERAPY/EXERCISES GP
    Allow 97530 08/09/2011 THERAPEUTIC ACTIVITIES GP
    Allow 97140 08/09/2011 MANUAL THERAPY GP
    Allow 97124 08/09/2011 MASSAGE THERAPY GP

    The results displayed do not guarantee how the claim will be processed.


    Now this info I got off of Ingenix Encoder:


    CCI Mutually Exclusive

    Warning: These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation.

    Code Description Fee FA_Total Fee Work RVU PE RVU FA_PE RVU MP RVU Total RVU FA_Total RVU Fee Type Modifier Primary or Secondary
    97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes $27.86 $27.86 0.43 0.38 0.38 0.01 0.82 0.82 Non Facility Allowed N/A
    97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes $32.28 $32.28 0.44 0.5 0.5 0.01 0.95 0.95 Non Facility Allowed N/A


    Code Description Fee FA_Total Fee Work RVU PE RVU FA_PE RVU MP RVU Total RVU FA_Total RVU Fee Type Modifier Primary or Secondary
    97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes $32.28 $32.28 0.44 0.5 0.5 0.01 0.95 0.95 Non Facility Allowed N/A
    97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes $27.86 $27.86 0.43 0.38 0.38 0.01 0.82 0.82 Non Facility Allowed N/A


    It looks like they are payable w/ modifiers. I would try mod 59 on all but 97140

  8. #8
    Location
    Phoenix, AZ
    Posts
    620
    Default
    You cannot bill 97124 and 97140 together UNLESS the PT has documented that he/she performed myofascial release AND massage therapy on the same date and to different body areas on the same date. The reason is that the PT would very rarely perform MT and myofascial release modalities together. Check with your PT.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  9. #9
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Smile
    Wow, you clearly put a lot of effort into trying to help me w/this & I greatly appreciate that. I agree w/you, unfortunately the claim scrubber disagrees. I think what I'm going to do is bypass the system & hope it pays. We learn from our mistakes, RIGHT?
    Thanks again.

  10. #10
    Location
    St Louis West Missouri Chapter
    Posts
    15
    Default
    Thank you Cyndi. I did review the records briefly, but I will call the PT and ask that question specifically. Do you bill for PT/OT?

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