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Physical therapy with 59 modifier

  1. #1
    Location
    Salt Lake City
    Posts
    841
    Default Physical therapy with 59 modifier
    Medical Coding Books
    Ok my thought o billing 97110, 97530 and 97150 would be add the 59 modifier on 97150 since that code is unbundled to both of the other charges but we have recieved some information that you would add 59 modifier to 97110 and 97530. This makes no sense to me can someone explain?
    Jenifer McPolin CPC, CPMA, RCC

  2. #2
    Location
    Baton Rouge
    Posts
    1,241
    Default
    97110 and 97530 are both listed in Column 2 of the Mutually Exclusive Edits for 97150, but with a modifier allowance of 1. The codes listed in Column 2 are the ones that will get the 59 modifier. Hope that explains it!

    Also, here's the link to the most recent NCCI Edits, if you need it.

    http://www.cms.gov/NationalCorrectCo...CCIEP/list.asp
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. #3
    Location
    Salt Lake City
    Posts
    841
    Default
    It just makes no sense with the RVU value on 97150 being so low.
    Jenifer McPolin CPC, CPMA, RCC

  4. #4
    Location
    Baton Rouge
    Posts
    1,241
    Default
    I agree but seems like there are quite a few pairs in which the lower value code is considered primary for CCI purposes.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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