Eli's Rehab Report

Question: When is it appropriate to use code Q0086?

Georgia Subscriber

Answer: In Georgia, Q0086 (physical therapy evaluation/treatment, per visit) is used only to bill Part A for physical therapy services. Georgia Medicare Part B does not recognize Q0086, although this rule varies by state, as do the rules for the actual coding. Because the descriptor reads, evaluation/treatment, different carriers can interpret the code in different ways.

For example, if a stroke (436) patient receives weekly neurocognitive therapy in a hospital setting, depending on the insurer, the therapist might code Q0086 to reflect treatment. Another carrier, however, might say that Q0086 should only be coded by physicians who visit rehabilitation facilities to evaluate the patients physical therapy regimen. This is one example where it is essential that you contact your local insurer before coding.