Guidance for the Use of Codes in Physical Medicine - Pub-100

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 10th, 2016

The following provides guidance about the use of codes 9610597026971509754597546, and G0128.

• CPT Codes 9610597545, and 97546.

Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units. This code represents formal evaluation of aphasia with an instrument such as the Boston Diagnostic Aphasia Examination. If this formal assessment is performed during treatment, it is typically performed only once during treatment and its medical necessity should be documented. If the test is repeated during treatment, the medical necessity of the repeat administration of the test must also be documented.

It is common practice for regular assessment of a patient’s progress in therapy to be documented in the chart, and this may be done using test items taken from the formal examinations. This is considered to be part of the treatment and should not be billed as 96105unless a full, formal assessment is completed.

Other timed physical medicine codes are 97545 and 97546. The interval for code 97545 is 2 hours and for code 97546, 1 hour. These are specialized codes to be used in the context of rehabilitating a worker to return to a job. The expectation is that the entire time period specified in the codes 97545 or 97546 would be the treatment period, since a shorter period of treatment could be coded with another code such as codes 9711097112, or 97537. (Codes 97545 and 97546 were developed for reporting services to persons in the worker’s compensation program, thus we do not expect to see them reported for Medicare patients except under very unusual circumstances.

Further, we would not expect to see code 97546 without also seeing code 97545 on the same claim.

Code 97546, when used, is used in conjunction with 97545.)

References:

Guidance for the Use of Codes in Physical Medicine - Pub-100. (2016, August 10). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/guidance-for-the-use-of-codes-in-physical-medicine-pub-100-31593.html

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