Wiki 97164

[chantalbaird@gmail.com]

Hi, This is my post in the forum and newly certified. I’m currently work in a physical therapy office. We were discussing utilizing the re-eval. code 97164. I understand that there are some guidelines when it’s appropriate to use this code. In addition that the modifier 59 would need to be added to additional codes used like for manual therapy, therapeutic exercises, and activities.

They have never used the code and are hesitant to do so.

Questions
1.) can you apply the modifier multiple codes, ie. Exercise and activities when billing with the 97164.
2.) Beyond the general guidelines of when it’s appropriate to use 97164. Has anyone had any experience with it being denied for an unforeseen reason.
3.) Any info regarding this code is welcome.

Thank you so much

 

[mnuhfer04]

Hi! I still consider myself a new coder, but I bill/code for a primary care office which also has a physical therapy dept. Around the begging of 2020 we were getting paid for a 97164 using modifier 59 with other services like you mentioned, but the past few months they are denying. I have been reading up on some other modifiers (XE, XS, XP and XU) and that these modifiers are taking over for modifier 59. I wonder if anyone else has some advice on this matter.

 

[shannonbohner]

Hi, This is my post in the forum and newly certified. I’m currently work in a physical therapy office. We were discussing utilizing the re-eval. code 97164. I understand that there are some guidelines when it’s appropriate to use this code. In addition that the modifier 59 would need to be added to additional codes used like for manual therapy, therapeutic exercises, and activities.

They have never used the code and are hesitant to do so.

Questions
1.) can you apply the modifier multiple codes, ie. Exercise and activities when billing with the 97164.
2.) Beyond the general guidelines of when it’s appropriate to use 97164. Has anyone had any experience with it being denied for an unforeseen reason.
3.) Any info regarding this code is welcome.

Thank you so much

Did you ever get any further info on this? I am currently experiencing denials whenever code 97164 is billed and I can't figure it out or find anything helpful online... It seems like something happened in October of 2020 that changed billing for this code and there is no clear direction I can find.

 

[mnuhfer04]

Did you ever get any further info on this? I am currently experiencing denials whenever code 97164 is billed and I can't figure it out or find anything helpful online... It seems like something happened in October of 2020 that changed billing for this code and there is no clear direction I can find.

Hi, we have been using modifier XU and have been getting paid for a couple years now. https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf