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2 different dx

  1. Smile 2 different dx
    Medical Coding Books
    I work for a physical therapy office and we are seeing a medicare patient for 2 different dx at the same time. We billed 97110 for each dx and medicare is only paying on 1 dx and denying the other as a duplicate (97110)
    How can we rebill this to get reimbursed?

  2. #2
    Location
    Fayetteville, NC
    Posts
    300
    Default
    In the description of the code 97110 it says:
    "Therapeutic procedure, 1 or more areas each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility"

    So it looks to me as if this code can only be billed once per day.
    Last edited by Grintwig; 12-07-2011 at 12:42 PM. Reason: Speeling error
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  3. Default 2 different dx
    For 1 dx which is v43.65 (Joint Replaced Knee) we are billing 97110 and the other dx 722.52 and 724.2 are also billed with 97110. Medicare has only been paying 1 dx with 97110 and denying the other as duplicate.
    The same PT is seeing the patient for these 2 different dx, would that change anything or is this code only billable 1 time?
    Last edited by shamikapollard; 12-07-2011 at 12:56 PM. Reason: Added more to comment

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by Grintwig View Post
    In the description of the code 97110 it says:
    "Therapeutic procedure, 1 or more areas each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility"

    So it looks to me as if this code can only be billed once per day.
    The code does show that it can be billed in 15 min units, so you need to find out how much time was spent in therapy and bill the appropriate units. You would just bill both diagnosis codes with the 97110 and then however many units of 15 min (eg, 30 min equals 2 units, 60 min equals 4 units).
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    I am billing the correct # of units, both encounters can not go over 6 units or medicare will not pay

  6. #6
    Location
    Greater Orlando
    Posts
    146
    Default
    How many units of treatment is each diagnosis requiring, per visit?
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  7. #7
    Default
    I do billing for a PT office and we see patients for more than 1 DX at a time but we still bill it as 1 claim just combining the units and adding the multiple DXs to each code. The only time we seperate out the claims is when the patient has PT and OT on the same day, then we can bill as 2 seperate visits because there are 2 specialty providers. You can append the GP/GO mods and support with notes and I have always been able to get these paid when appealing. Is there a medical necessity as to why you are splitting up the treatment as if there are 2 encounters using 2 different DX's. It may be best to limit the amount of time the PT is spending with the patient so it doesnt exceed the max units and maybe provide some home exercises or have them come in on a different day. Generally in our office if the patient has such a need to be treated seperately for different DX's its due to the extent of their injuries to where the beneifs to the patient far outweigh what we would like to be paid and we just cut our losses in the patients best interest, but still would not seperate the billing like you are doing.

  8. Default
    The second 97110 is denying for a duplicate because you do not have the 59 modifier attached to the second procedure.

  9. #9
    Location
    Salt Lake City
    Posts
    841
    Default
    you can only bill 97110 once it covers multiple body areas.
    Jenifer McPolin CPC, CPMA, RCC

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