Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jul 15th, 2020

The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.  

• When reporting 93668 for peripheral arterial disease rehabilitation the following ICD-10 codes must be reported per CMS.
• When reporting in a group session 93668 is reported once per patient per session.

Per MLN MM10295, “Medicare will reject claims with CPT 93668 which exceed 36 sessions within 84 days from the date of the first session when the KX modifier is not included on the claim line OR any SET session provided after 84 days from the date of the first session and the KX modifier is not included on the claim.”

In addition, the following revenue codes reported with 93668 will be denied by Medicare per MLN # 11022: “Medicare will not pay claim lines for SET services billed with CPT 93668 with revenue codes 096X, 097X, or 098X when billed on TOB 85X Method II Critical Access Hospitals (CAHs)”.