Wiki 96132,96136,96137 HELP Sports medicine provider

[allisondisla@gmail.com]

I'm looking for some help regarding the specific codes 96132,96136,96137. My provider is a Sports medicine provider whos a part of a large medical group. He's being denied on these three codes for inclusive or non covered charge, Mostly inclusive. What is he doing wrong. Most of the time he's including an ov e&m with these codes as well and Sway testing codes. We've told him he will not be paid on Sway codes as he is not a physical therapist but not sure why all the others are denying. He's doing everything same day. no need to hold and bill on completed day. He sees mostly kids with sports concussions, no fault and workers comp. Any advice would be helpful. Thank you in advance.

 

[csperoni]

I don't bill sports medicine, but my guess is the E/M and additional codes are NCCI edits. When I ran 99204 with 96136 for example, it comes up as bundled, but may be overriden with a modifier only if appropriate.

 

[amyjph]

Like Christine said, they are bundled if reporting an E&M on the same date of service. If it's non-covered the payer may not cover the CPT and/or it's not in the contract. Many payers only cover this under a mental health benefit. Also, they are time based codes which require total time and start and stop times. They require interpretation and report. If you read the CPT descriptions they are very specific as to what is required and included/excluded. The documentation must be very clear, and very good to support billing this if you try to use a 59 modifier. Is the provider really spending and documenting the required minutes in addition to the E&M separately or performing tests during the exam that are part of the credit for the E&M?

Info article: https://impacttest.com/wp-content/uploads/billing-guide-impact-applications.pdf

This is just an FAQ found searching, it's old but has some info on the codes: https://www.bluecrossmn.com/sites/d...chological and Neuropsychological QP40-20.pdf
WPS Article example: https://www.cms.gov/medicare-covera...,F,P&contractOption=all&sortBy=relevance&bc=1