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Reader Question: Coding for 97116 and 97002

Is 97116 a comprehensive code or in exclusion of 97002 (re-evaluation)? We are getting this rejected from Medicare, but I only have access to Correct Coding Initiative (CCI) edits V6.2 and its not there. Is it in version 6.3?

Georgia Subscriber

Answer: Yes, it is in version 6.3. According to CCI version 6.3, 97002 (physical therapy re-evaluation) is considered a bundled component of 97116 (gait training, [includes stair climbing]). However, there is a 1 superscript on the 97002 indicating you may be paid for both a comprehensive and a component code if an appropriate modifier is used and the medical record documentation can support distinct procedural service (modifier -59).

Sources for Reader Questions and You Be the Expert are Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc., an emergency medicine coding company based in Jacksonville, Fla.; Ruthie Burden, CCS, CPC, CPAR, who works in the medical records coding office at St. Joseph Hospital in Augusta, Ga.; Paula Furlan, senior consultant Beacon Partners Inc., Norwell, Mass.; and George M. Chiu, RHIA.

- Published on 2001-01-01

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