Wiki 29581 Denials

[amberw1]

HI,
I currently do physical therapy billing for Indiana providers and our therapists were told at a conference that they could now bill the 29581 for the application of compression garments for their patients, but we are receiving a lot of denials for this code, mostly the CO4 modifier denial and nothing I do seems to work to overturn it. We were initially instructed by WEBPT to bill as 29581 GP 59, we've since updated this to include the appropriate site modifier RT, LT or 50 but they are still being denied. Any suggestions would be amazing!
Thanks!

 

[thomas7331]

A couple of things to start with: First of all, CPT code 29581 is for application of multi-layer compression dressing systems - it's not for 'compression garments'. This is a service mainly for treatment of wounds, so if the therapists are using this code to report other things such as compression stockings, that's just incorrect. Second, I'd mention that modifiers aren't something that are meant just to be applied to CPT codes for purposes of getting claims paid, especially modifier 59 which can only be used in specific situations where the documentation supports it. In any case, modifier 59 is for unbundling for which you would usually see a different denial code than CO-4, and that modifier is only warranted when the records indicate that the service is distinct from another service that you have reported on the same date.

Other than the GP and laterality modifiers which you've already tried, I can't think of any other modifiers that payers commonly require that would trigger this denial code. I think you will need to work with the payer on this to try to determine what they are looking for in this situation. I would start by reviewing the reimbursement policies and your provider's contracts for the payers who are giving you this denial, and if that doesn't give you an answer, then I think you have to contact them directly for additional information. I'd advise against a trial-and-error approach to modifier use as that can lead to more problems in the long run and it's best to get a firm understanding of what the issue is before submitting corrected claims.