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97530 being used for Lifestyle Counseling

  1. #1
    Exclamation 97530 being used for Lifestyle Counseling
    Medical Coding Books
    I need help with this one. My boss insist that I use 97530 (which is clearly physical therapy code) for Lifestyle Counseling after doing a 93720 (Total Body Plethymography). Medicaid of NC clearly states that the provider is not able to performed 97530. Can anyone out there help me. I am tired of writing these off.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  2. Default Tough spot
    Your boss is putting you in a tough spot.... That code is clearly a PT (or even OT) code, and 97530 is used to report a series of movements involving multiple parameters (i.e., flexibility, strength, coordination) for recovery of everyday functionality.

    This code is intended for use by occupational therapists who receive the specific training needed to design therapeutic activities. If you have not received that specific training, you should not use this code.

    Your documentation would need to include start and stop times, exercise(s) performed, and what functionality you were trying to restore, etc. Obviously, you (he) would not be able to provide any of these.

    I am not exactly what sure what other code you should use, but a preventive medicine counseling code (9940X) may be appropriate. In any case, using 97530 is asking for trouble.

    I hope this helps. Good luck.[/FONT]

  3. #3
    Exclamation 97530 being used for Lifestyle Counseling
    Jeramy - thank you for your help on this one. I need to get more insite from other people here but if you dont mind, i will be putting some information together so that I can share not only with my providers but also my boss also. where can i find this in writting?
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

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