Muscle Testing and Range of Motion InformationNovember 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?October 16th, 2018 - Wyn Staheli, Director of Research
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 ...Rhizotomy ProceduresSeptember 26th, 2018 - BC Advantage
The terms “rhizotomy” and “Radiofrequency Ablation” (RFA) both mean “destruction of a nerve.” Another term for this is “neurolysis.” The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve(s). Nerve Destruction choices include the following: Chemical Neurolytic Blocks - These require substances that are...Q/A: Can I Bill Mechanical Massage?August 16th, 2018 - Wyn Staheli, Director of Research
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 - Wyn Staheli, Director of Research
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 - ChiroCode
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 - Wyn Staheli, Director of Research
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.Auditing Therapy Evaluation Codes - Not So Quick!June 4th, 2018 - Nancy J Beckley, MS, MBA, CHC
New evaluation codes for physical therapy (PT) and occupational therapy (OT) codes were made effective 1/1/2017. Three new physical therapy evaluation codes replaced 97001, and three new occupational evaluation codes replaced 97003. Chart 1 - Short Code Descriptors The PT and OT reevaluation codes remain the same but were...When is 97112 Neuromuscular Re-education Billable?March 13th, 2018 - Dr. Evan Gwilliam, VP for PayDC
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.Increased Therapy Denials Create Administrative BurdenMarch 5th, 2018 - Wyn Staheli, Director of Research
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 - Jared Staheli
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 ...Medicare Requiring Modifier GP on Physical Therapy ServicesFebruary 1st, 2018 - Wyn Staheli, Director of Research
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 (emphasis added):
Services furnished under the Outpatient ...Strapping and Kinesio Taping Coding DifferencesFebruary 1st, 2018 - Wyn Staheli, Director of Research
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally.
Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue.
Coding: ...Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) CodesFebruary 1st, 2018 - Find-A-Code
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, ...Medicare Requiring Specific Modifiers on Therapy ServicesJanuary 15th, 2018 - Wyn Staheli, Director of Research
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 - Wyn Staheli, Director of Research
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?Outpatient Rehabilitation ModifiersJanuary 9th, 2018 - Jared Staheli
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 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...Billing Negative Pressure Wound Therapy (NPWT) (disposable device)January 4th, 2018 - Find-A-Code
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 ...Diathermy eg Microwave Use and DocumentationJanuary 4th, 2018 - Find-A-Code
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 ...General Physical Therapy Modality GuidelinesJanuary 4th, 2018 - Find-A-Code
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 ...Hydrotherapy GuidelinesJanuary 4th, 2018 - Find-A-Code
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 ...Initial Evaluation Codes for PT's and OT'sJanuary 4th, 2018 - Find-A-Code
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 ...Mechanical Traction TherapyJanuary 4th, 2018 - Find-A-Code
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 ...Physical Therapist can now bill for a substitute Physical TherapistJanuary 4th, 2018 - Find-A-Code
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' ...Proper Usage of Electrical StimulationJanuary 4th, 2018 - Find-A-Code
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 ...PT and OT Reevaluation CodingJanuary 4th, 2018 - Find-A-Code
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 ...Reimbursement for Therapy StudentsJanuary 4th, 2018 - Find-A-Code
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 ...Skilled Therapy, When it's Appropriate and BillableJanuary 4th, 2018 - Find-A-Code
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, ...Ultrasound TherapyJanuary 4th, 2018 - Find-A-Code
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 ...