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Physical Therapy 97530 and 97110 - Medical Coding 4 года назад


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Physical Therapy 97530 and 97110 - Medical Coding

Handouts, transcripts, enhanced video replay and instructor access are available to CCO Club members. If you are interested in membership visit http://cco.us/club. Q: Was hoping to help on coding, billing for Physical therapy 97530 Therapeutic Activities and 97110 Therapeutic Exercise with Mods GP, KX appended to both. Claims are being denied due to 236, 45. Procedure/mod combo, NCCI edit was not billable together but has deletion date. A: Coach Jennifer: CO-45 is an adjustment. That’s not a valid denial code. I’d have to see what the other actual codes are. A 45 is a contractual adjustment but that one I know. I see it every time. I used to bill 97530 and 97110 in Physical Therapy all the time but this was back 15 or so years ago. We didn’t need a modifier on either of them. I don’t think I have the right book in front of me. What is a GP? I’ll have to go and look them up. Coach Alicia: If I try to look them up, I won’t be able to do it on my computer. Are you able to? Coach Jennifer: No, I got them. Coach Alicia: While she’s doing that, Tiffany and I were talking about this because she was creating some exam questions for us and we were talking about physical therapy and it’s actually this afternoon. Coach Jennifer: Some therapy modifier. Coach Alicia: It’s time based and stuff. So it’s really unique to code for physical therapy. Coach Jennifer: I really liked it when I did it. I really enjoyed it. “GP indicates if a physical therapy services have been provided. It’s commonly used in inpatient and outpatient multidisciplinary settings. Used for functional limiting reporting. Used as modifier in any case where there could be a confusion as to which provider delivered the services to a patient, such as an interdisciplinary therapy setting.” So to me, I read that as it’s not necessary unless you have multiple disciplines in your physical therapy and the patient was having multiple things at one time. KX – “After the patient has exceeded their Medicare threshold, then you bill the KX.” So throughout the year they require a therapy perhaps something else. Say, they had a hip replacement, had lots of therapy and now they have a new problem, and so they’ve exceeded that threshold, so the therapist bills it to justify that continued care. So that one I can see being on something because, yeah, they gone past and Medicare patient’s gone past, and that’s Medicare. You’re not going to use that with any other insurance companies. But the GP, only if you have other people doing those services as well. I won’t see needing the GP modifier unless you’re in a multiple discipline setting. If you’re using both of them on the same claim, then yeah that could be why they’re denying. Coach Alicia: This might be something that we can do some topic request on, more information on Physical Therapy. So the courses… the last one was good. Coach Jennifer: There are so many changes right now coming up with physical therapy. The biggest one is physical therapists will now be MDs. Physical therapy is now a doctor program. Coach Alicia: They have one? Wow! I did not know that. Coach Jennifer: All of them will now be credentialed. Coach Alicia: Oh! Coach Jennifer: It was a Bachelor when I first wanted to go into it and then it became a Master at that time. Now, it’s MD, PhD level. Coach Alicia: I knew that they had a Master’s degree because that’s at the hospital way back in the day that you had one… the supervisor, the person that ran the physical therapy department because they were right across the hall from us in our department, we were always in the basement. Almost everybody had a Bachelor’s degree but the person that ran had a Master’s. But, wow!

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