# Physical Therapy modifiers



## medicalcoder519@yahoo.com (Aug 9, 2011)

PT coders: does anyone know how to code 97110, 97113, & 97530 on same bill? I know mod 59 gets attached to 97530, but I don't know which other code gets a mod. I'm also having a problem billing 97124 with 97140. Help is appreciated; need to get these claims OUT.
Thanks!!


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## tdml97@yahoo.com (Aug 9, 2011)

All of your codes should have mod GP.

What kind a rej are you getting for 97124/97140?


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## medicalcoder519@yahoo.com (Aug 9, 2011)

It's Mdcr, so I did apply GP to all codes, but on the one claim, the claim scrubber is stating the following:
Trigger Procedure 97140 on Visit #228035, Line #3  and Target Procedure 97124 on Visit #228035, Line #2 are Unbundled and the TARGET is inappropriate. The Standard Policy Statement reads "Standards of medical / surgical practice".
On the other claim:
Trigger Procedure 97530 on Visit #226677, Line #2 and Target Procedure 97113 on Visit #226677, Line #1 are Unbundled and the Target is inappropriate. The Standard Policy Statement reads "More extensive procedure".
Does this make sense to you??


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## tdml97@yahoo.com (Aug 9, 2011)

So, these have not been billed out yet?


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## medicalcoder519@yahoo.com (Aug 9, 2011)

No. Trying to get it right the 1st time out. My employer frowns on denials.


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## medicalcoder519@yahoo.com (Aug 9, 2011)

Do you understand those msgs? I thought I did at 1st, but every combination I've tried, doesn't fly.


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## tdml97@yahoo.com (Aug 9, 2011)

FYI - I am not a coder (cert. in medical billing).  I have no idea what they are talking about.  

This is what I found on HAPs website - clear claim connection:


Click on recommendation of "Disallow" or "Review" to obtain clinical edit clarification. 

Line Procedure Description Mod 1 Mod 2 Quantity Date of Service Place of Service Payment RVU Pay % Recommend 

1 97140 MANUAL THERAPY                          1.00 8/1/2011 11 (Office) n/a 0 Allow 
2 97124 MASSAGE THERAPY                  59  1.00 8/1/2011 11 (Office) n/a 0 Disallow     
3 97530 THERAPEUTIC ACTIVITIES        59  1.00 8/1/2011 11 (Office) n/a 0 Allow 
4 97113 AQUATIC THERAPY/EXERCISES 59  1.00 8/1/2011 11 (Office) n/a 0 Allow 

Per HAP - 97124 is included w/ 97140

Inquiry:
Why is this procedure disallowed? 
Procedure Description 
97124 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION) 
97140 MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), 1 OR MORE REGIONS, EACH 15 MINUTES 

Response:
HCPCS/CPT codes define procedures include services that are integral. Integral services have CPT codes for reporting service when not performed as an integral part of another procedure. Services integral to HCPCS/CPT code are procedures included in services based on standards of medical/surgical practice. It is inappropriate to report services alone that are integral to another procedure.NCCI edits are based on standards of medical/surgical practice. Services that are integral to another become component parts of comprehensive service. Integral component services have their own HCPCS/CPT codes, NCCI edits place comprehensive service in column one and component service in column two. A component service integral to comprehensive service is not separately reportable; column two codes can not be reported separately with column one code.Services are integral to large numbers of procedures. Other services are integral to a limited number of procedures. Examples of large number of procedures include:" Cleansing, shaving and prepping of skin" Draping and positioning" Insertion of intravenous access for medication administration" Insertion of urinary catheter" Sedative administration by physician performing procedure (Chapter II, Anesthesia Services)" Local, topical or regional anesthesia administered by physician performing procedure" Surgical approach including identification of anatomical landmarks, incision, evaluation of surgical field, debridement of traumatized tissue, lysis of adhesions, isolation of structures limiting access to surgical field such as bone, blood vessels, nerve, muscles including stimulation for identification or monitoring" Surgical cultures" Wound irrigation" Insertion/removal of drains, suction devices, pumps into same site" Surgical closure and dressings" Application, management, and removal of postoperative dressings and analgesic devices (peri-incisional" TENS unit" Institution of Patient Controlled Anesthesia" Preoperative, intraoperative and postoperative documentation, including photographs, drawings, dictation, or transcription necessary to document services provided" Surgical supplies, for specific situations where CMS policy permits separate paymentChapters in Manual address issues related to standards of medical/surgical practice for procedures covered. It is not possible because of space limitations to discuss all NCCI edits based on principle of standards of medical/surgical practice. There are general principles that can be applied to edits as follows:" Component service is accepted standard of care when performing comprehensive service." Component service usually necessary to complete comprehensive service." Component service is not separate procedure when performed with comprehensive service. 
Therefore, this procedure is not recommended for separate reimbursement. 


Now this is what I found on BC's web site clear claim connection:

Claim Audit Results  


--------------------------------------------------------------------------------



 Gender:           Date of Birth:      


 Recommend Procedure Date of Service Description Modifiers 
Allow  97113 08/09/2011 AQUATIC THERAPY/EXERCISES GP 
Allow  97530 08/09/2011 THERAPEUTIC ACTIVITIES GP 
Allow  97140 08/09/2011 MANUAL THERAPY GP 
Allow  97124 08/09/2011 MASSAGE THERAPY GP         

 The results displayed do not guarantee how the claim will be processed.  


Now this info I got off of Ingenix Encoder:


 CCI Mutually Exclusive      

 Warning: These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation.  

Code  Description  Fee FA_Total Fee  Work RVU PE RVU FA_PE RVU  MP RVU Total RVU FA_Total RVU  Fee Type Modifier  Primary or Secondary  
97140  Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes  $27.86  $27.86  0.43  0.38  0.38  0.01  0.82  0.82  Non Facility Allowed   N/A  
97530  Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes  $32.28  $32.28  0.44  0.5  0.5  0.01  0.95  0.95  Non Facility Allowed   N/A  


Code  Description  Fee FA_Total Fee  Work RVU PE RVU FA_PE RVU  MP RVU Total RVU FA_Total RVU  Fee Type Modifier  Primary or Secondary  
97530  Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes  $32.28  $32.28  0.44  0.5  0.5  0.01  0.95  0.95  Non Facility Allowed   N/A  
97140  Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes  $27.86  $27.86  0.43  0.38  0.38  0.01  0.82  0.82  Non Facility Allowed   N/A  


It looks like they are payable w/ modifiers.  I would try  mod 59 on all but 97140


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## Cyndi113 (Aug 9, 2011)

You cannot bill 97124 and 97140 together UNLESS the PT has documented that he/she performed myofascial release AND massage therapy on the same date and to different body areas on the same date. The reason is that the PT would very rarely perform MT and myofascial release modalities together. Check with your PT.


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## medicalcoder519@yahoo.com (Aug 9, 2011)

Wow, you clearly put a lot of effort into trying to help me w/this & I greatly appreciate that. I agree w/you, unfortunately the claim scrubber disagrees. I think what I'm going to do is bypass the system & hope it pays. We learn from our mistakes, RIGHT? 
Thanks again.


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## medicalcoder519@yahoo.com (Aug 9, 2011)

Thank you Cyndi. I did review the records briefly, but I will call the PT and ask that question specifically. Do you bill for PT/OT?


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## Cyndi113 (Aug 10, 2011)

I used to work for a PT/OT/MT company for 13.5 years. I'm always happy to see a therapy question.


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## MARIASOTO (Jun 20, 2018)

Needing input on what everyone is using when a Physical Therapist is seeing patient twice for two different issues. From reading past threads some are leaning towards 59 or XE while others mentioned the use of 76 modifier. Any help with this would be greatly appreciated

Thank you


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