Eli's Rehab Report

Question: What happens if physical therapy and occupational therapy is working on the same patient and both disciplines use the same CPT® code on the same day? For example, if both disciplines are working on therapeutic exercise on the same day and thus both billing 97110, would that create a problem with billing? If it’s legit, is there a modifier we can use or a way to let the payer know that this isn’t double-billing?

Answer: There’s no problem with billing the same CPT® code on the same day when PT and OT are both doing therapeutic exercise, for example, under Medicare Part B benefits. However, the PT and OT should be using this intervention for different goals for this billing to be compliant. For example, a patient is receiving both PT and OT for an exacerbation of multiple sclerosis. The PT could be providing therapeutic exercises to strengthen the patient’s lower extremities to prevent falls due to muscle weakness and buckling of the knee during weight bearing, while the OT is using therapeutic exercises to strengthen the patient’s upper extremities so she can complete ADLs and function independently at home.

Documentation would need to support the need for both physical and occupational therapy services for the patient, and the documentation should show the impairments (i.e., range of motion and strength deficits, balance, flexibility, etc.) that cause the functional limitations or safety risks that the patient is experiencing.

Under Medicare Part B benefits, if PT and OT both bill the same CPT® code on the same calendar day, modifier 59 is not required for that reason.

For non-Medicare: Whether OT and PT can both bill the same CPT® code on the same calendar day is payer-specific. There are non-Medicare payers who do allow patients to receive both PT and OT on the same calendar day for the same diagnosis — and the PT and OT can bill the same CPT® codes as long as they are using those interventions to work on separate and distinct goals.

Don’t miss: There may also be some payers who do not allow the patient to receive both PT and OT on the same calendar day for the same diagnosis — or may allow both PT and OT on the same day, but the PT and OT can’t be reimbursed for the same CPT® codes. Your best bet is to verify the patient’s benefit coverage in advance of providing the therapy services.