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News and Important InformationPodiatrist Billing for Physical Therapy MLN - OP Rehabilitation Therapy Services - Complying with Documentation Requirements ImagesCode SetsCPT CodesCPT Procedure Codes ICD-10-CM CodesICD-10-CM Diagnosis Codes Find-A-Code's Tools & ResourcesClick-A-Dex™Click-A-Dex™ Index Search Tool Build-A-CodeStep-by-step coding from all major code sets. NCCI Edits ValidatorValidate using NCCI edits for errors in code selection. Pro-Fee CalculatorVerify Professional Fees for reimbursement. Commercial Payer PoliciesView Clinical Indications for Medical necessity on procedures, Suggested Code Selection to assist your clinical judgment includes citations. Find-A-NPI™Find-A-NPI™ Fast Provider Lookup Additional Links and ResourcesNoridian: Outpatient Therapy ResourcesNoridian JE Part B Outpatient Therapy Resources MLN Education ToolQuick Reference Chart: Descriptors of G-codes and Modifiers for Therapy Functional Novitas: Physical Therapy Plan of CareNovitas: Physical Therapy Plan of Care Requirements Physical Therapy ArticlesClick the article title to view a summary and link to the full article. Medical ID TheftAugust 16th, 2019 | Published August 16th, 2019 - Last Review/Update August 20th, 2019 Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ... The OIG Work Plan: What Is It and Why Should I Care?August 9th, 2019 | Published August 9th, 2019 - Last Review/Update August 14th, 2019 The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ... Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back PainJuly 17th, 2019 | Published July 17th, 2019 Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment. Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?July 15th, 2019 | Published July 15th, 2019 Question:
It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ... 5 Ways to Minimize HIPAA LiabilitiesJuly 12th, 2019 | Published July 12th, 2019 - Last Review/Update July 30th, 2019 Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ... Will the New Low Level Laser Therapy Code Solve Your Billing Issues?July 8th, 2019 | Published July 8th, 2019
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:
Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ... Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?May 27th, 2019 | Published May 27th, 2019 - Last Review/Update June 6th, 2019 Question
Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3.
Also, it shows the ... RT and LT Modifier Usage Change (effective 2019-03-01)May 21st, 2019 | Published May 21st, 2019 According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ... Electrical Stimulation and Electromagnetic Therapy DevicesMay 13th, 2019 | Published May 13th, 2019 - Last Review/Update May 20th, 2019 Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint. Podiatrist Billing for Physical TherapyMarch 7th, 2019 | Published March 7th, 2019
It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ... Physical Therapy Caps Q/AFebruary 1st, 2019 | Published February 1st, 2019 - Last Review/Update February 4th, 2019 Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ... CPT Modifiers 96 & 97 for Habilitative and Rehabilitative Services (2018-01-01)January 22nd, 2019 | Published January 22nd, 2019
Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. There have been questions on whether modifier 96 will be preferred over HCPCS modifier SZ, which describes the same types of habilitative (but not rehabilitative) services, but payers have not yet indicated which modifier ... Billing Exercise EquipmentNovember 29th, 2018 | Published November 29th, 2018 While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ... Muscle Testing and Range of Motion InformationNovember 8th, 2018 | Published November 8th, 2018 Be sure to understand the unique code requirements for Muscle and Range of Motion Testing. Wolters Kluwer Drug PricingOctober 17th, 2018 | Published October 17th, 2018 Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average... Pelvic Floor Dysfunction Treatment CoverageOctober 16th, 2018 | Published October 16th, 2018 Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings.
Coverage by payers ... Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?October 16th, 2018 | Published October 16th, 2018
Question:
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ... Q/A: Can I Bill Mechanical Massage?August 16th, 2018 | Published August 16th, 2018 - Last Review/Update January 30th, 2019 Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code. Q/A: Can I Bill Spinal Decompression Table to Insurance?July 25th, 2018 | Published July 25th, 2018 - Last Review/Update January 28th, 2019 Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended? Q/A: Should I Bill Massage as 97124 or 97140?June 20th, 2018 | Published June 20th, 2018 - Last Review/Update January 30th, 2019 Question
The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ... Q/A: Can a PT Assistant Perform Physical Therapy Modalities?June 18th, 2018 | Published June 18th, 2018 - Last Review/Update January 30th, 2019 Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more. Coding for Strains in ICD 10May 30th, 2018 | Published May 30th, 2018 - Last Review/Update June 4th, 2018 According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows.... When is 97112 Neuromuscular Re-education Billable?March 13th, 2018 | Published March 13th, 2018 - Last Review/Update January 31st, 2019 Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received. Documentation for Home Health Services (Part A non DRG)March 8th, 2018 | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medical Learning Network provides coverage guidance, which should be documented, for home health services. Documentation and Orders for Respiratory Assistive DeviceMarch 8th, 2018 | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines. Documentation for Inpatient Rehabilitation FacilitiesMarch 8th, 2018 | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF). Increased Therapy Denials Create Administrative BurdenMarch 5th, 2018 | Published March 5th, 2018 Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ... CPT Modifers 96 & 97 for Habilitative and Rehabilitative ServicesFebruary 27th, 2018 | Published February 27th, 2018 Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. CMS has added modifiers 96 and 97 to their edits (see MLN Matters MM10385 here) and modifier SZ is deleted as of December 31, 2017. Private payers should simply adjust their policies to use ... Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) CodesFebruary 1st, 2018 | Published February 1st, 2018 According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ... Insufficient Documentation ErrorsJanuary 29th, 2018 | Published January 29th, 2018 According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims ... Medicare Requiring Specific Modifiers on Therapy ServicesJanuary 15th, 2018 | Published January 15th, 2018 Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ... Billing with a GP ModifierJanuary 15th, 2018 | Published January 15th, 2018 - Last Review/Update January 30th, 2019 Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter? Should ROM Testing be Reported with Evaluation and Management Services?January 9th, 2018 | Published January 9th, 2018 Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to. Outpatient Rehabilitation ModifiersJanuary 9th, 2018 | Published January 9th, 2018 Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries.
For services delivered under an outpatient plan of care use modifier:
GN for speech-language pathology
GO for occupational therapy
GP for physical therapy
In addition to using the correct modifier, ... Beware of Limitations When Using Electrical Stimulation - UltrasoundJanuary 4th, 2018 | Published January 4th, 2018 Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ... Reimbursement for Therapy StudentsJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ... Proper Usage of Electrical StimulationJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment.
97032 is a constant attendance electrical stimulation modality ... Skilled Therapy, When it's Appropriate and BillableJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators,
"A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ... Initial Evaluation Codes for PT's and OT'sJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation.
These evaluation codes are untimed, billable as one unit.
Do ... PT and OT Reevaluation CodingJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ... General Physical Therapy Modality GuidelinesJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention.
CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ... Diathermy eg Microwave Use and DocumentationJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ... Ultrasound TherapyJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to
3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ... Hydrotherapy GuidelinesJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ... Physical Therapist can now bill for a substitute Physical TherapistJanuary 4th, 2018 | Published January 4th, 2018 As of 6/13/2017 Medicare contractors shall accept claims from Physical Therapists, Provider Specialty 65 – Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier.
The A/B MAC Part B may pay the patient’s regular physician for physicians' ... Billing Negative Pressure Wound Therapy (NPWT) (disposable device)January 4th, 2018 | Published January 4th, 2018 Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes:
97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ... Mechanical Traction TherapyJanuary 4th, 2018 | Published January 4th, 2018 According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ... There are more articles. View all articles... View articles for the current specialty by subtopic: Physical Therapy TipsAccess to this feature is available in the following products:
Click here to Sign In to your account. Physical Therapy WebinarsClick the webinar title to view a summary and link to the webinar video. E/M and the Organ Systems Part 2 of 2February 28th, 2019 E/M and the Organ Systems Part 2 of 2 Joints: Rotator Cuff, Elbow, Wrist, and HandJanuary 14th, 2019 In this webinar, Brandon will review the bones and major joints of the upper extremities (arm, forearm, wrist, hand, and digits), as well as their supporting structures and how they are affected by injury, disease, and other conditions. All About Knee Coding & AuditingJanuary 14th, 2019 Total knee replacement now acceptable ASC procedure also, not auditing for a year.
Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers. Anatomy of the KneeJanuary 14th, 2019 Coders and billers in orthopedic practices must
understand the knee extensively. Join Dee to
master the anatomy of the knee joint, and
understand how it applies to ICD-10-CM
diagnosis coding. Proper Coding and Billing for Drugs, Biologicals and InjectionsJanuary 15th, 2019 Proper Coding and Billing for Drugs, Biologicals and Injections How to Check NCCI Edits Using FindACodeJanuary 15th, 2019 How to Check NCCI Edits Using FindACode ICD-10-CM Training - Session 08January 21st, 2019 ICD-10-CM Training - Session 08 ICD-10-CM Training - Session 07January 21st, 2019 ICD-10-CM Training - Session 07 ICD-10-CM Training - Session 06January 21st, 2019 ICD-10-CM Training - Session 06 ICD-10-CM Training - Session 05January 21st, 2019 ICD-10-CM Training - Session 05 ICD-10-CM Training - Session 36January 22nd, 2019 ICD-10-CM Training - Session 36 ICD-10-CM Training - Session 35January 22nd, 2019 ICD-10-CM Training - Session 35 ICD-10-CM Training - Session 34January 22nd, 2019 ICD-10-CM Training - Session 34 ICD-10-CM Training - Session 33January 22nd, 2019 ICD-10-CM Training - Session 33 ICD-10-CM Training - Session 04January 21st, 2019 ICD-10-CM Training - Session 04 ICD-10-CM Training - Session 32January 22nd, 2019 ICD-10-CM Training - Session 32 ICD-10-CM Training - Session 31January 22nd, 2019 ICD-10-CM Training - Session 31 ICD-10-CM Training - Session 03January 21st, 2019 ICD-10-CM Training - Session 03 ICD-10-CM Training - Session 02January 21st, 2019 ICD-10-CM Training - Session 02 ICD-10-CM Training - Session 30January 22nd, 2019 ICD-10-CM Training - Session 30 ICD-10-CM Training - Session 29January 22nd, 2019 ICD-10-CM Training - Session 29 ICD-10-CM Training - Session 28January 22nd, 2019 ICD-10-CM Training - Session 28 ICD-10-CM Training - Session 27January 22nd, 2019 ICD-10-CM Training - Session 27 ICD-10-CM Training - Session 01January 21st, 2019 ICD-10-CM Training - Session 01 ICD-10-CM Training - Session 26January 21st, 2019 ICD-10-CM Training - Session 26 ICD-10-CM Training - Session 25January 21st, 2019 ICD-10-CM Training - Session 25 ICD-10-CM Training - Session 24January 21st, 2019 ICD-10-CM Training - Session 24 ICD-10-CM Training - Session 23January 21st, 2019 ICD-10-CM Training - Session 23 ICD-10-CM Training - Session 22January 21st, 2019 ICD-10-CM Training - Session 22 ICD-10-CM Training - Session 21January 21st, 2019 ICD-10-CM Training - Session 21 ICD-10-CM Training - Session 20January 21st, 2019 ICD-10-CM Training - Session 20 ICD-10-CM Training - Session 19January 21st, 2019 ICD-10-CM Training - Session 19 ICD-10-CM Training - Session 18January 21st, 2019 ICD-10-CM Training - Session 18 ICD-10-CM Training - Session 17January 21st, 2019 ICD-10-CM Training - Session 17 ICD-10-CM Training - Session 16January 21st, 2019 ICD-10-CM Training - Session 16 ICD-10-CM Training - Session 15January 21st, 2019 ICD-10-CM Training - Session 15 ICD-10-CM Training - Session 14January 21st, 2019 ICD-10-CM Training - Session 14 ICD-10-CM Training - Session 13January 21st, 2019 ICD-10-CM Training - Session 13 ICD-10-CM Training - Session 12January 21st, 2019 ICD-10-CM Training - Session 12 ICD-10-CM Training - Session 11January 21st, 2019 ICD-10-CM Training - Session 11 ICD-10-CM Training - Session 10January 21st, 2019 ICD-10-CM Training - Session 10 ICD-10-CM Training - Session 09January 21st, 2019 ICD-10-CM Training - Session 09 There are more webinars. View all webinars... View webinars for the current specialty by subtopic: Physical Therapy Resources/Links
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