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Eli's Rehab Report

Reader Question:

Therapy Bundling

Published on Wed Aug 01, 2001

Question: I am having difficulty with CPT 97530 being bundled with an E/M service. The claim was also denied on appeal. What should I do?

Wisconsin Subscriber

Answer: Hundreds of medicine and diagnostic test codes were bundled with E/M services in version 6.3 of the national Correct Coding Initiative (CCI). The edits were withdrawn three months later following an outcry by physicians  and because the HCFA directive was not applied consistently across the country. Some carriers, however, have yet to remove the edit, which required that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to any E/M service billed during the same session as a modality or test, such as 97530 (therapeutic activities) and 97022 (whirlpool). Therefore, you may need to resubmit your E/M service with modifier -25. This indicates to the carrier that the E/M service provided was not simply a "premodality" evaluation, which would be included in the therapy code.
 
Although HCFA says the edits may be reinstated this summer, carriers that still require the modifier are violating HCFA's Dec. 21, 2000, directive suspending the edits. The oversight should be brought to the carrier's attention.

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