Wiki Can 97110 be billed with 97530?

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arinaab

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The practice I work for often uses 97110 and 97530 on the same date of service. From my research, I cannot get a clear answer on whether or not these two cpt codes can be billed together when a modifier is used. I'm the first Medical Coder that the company has had, and have taught myself a lot. Any help would be appreciated.
 
From a very basic perspective, according to NCCI edits, they can be billed together with no modifier. HOWEVER, this is a loaded question and there are other factors at play. Some of the key ones are: these are time based services, the eight minute rule, one-on-one direct patient contact, whether the payer has limits to the # of units/time for therapy per day, modality limits, etc. A payer might have made their own guideline regarding whether these are reportable together or not which might differ from NCCI.
The documentation has to be very clear as to what is being performed.

Sounds like you may want to look into a basic PT billing webinar or course (if you're doing outpatient PT?)
 
amyjph said:
From a very basic perspective, according to NCCI edits, they can be billed together with no modifier. HOWEVER, this is a loaded question and there are other factors at play. Some of the key ones are: these are time based services, the eight minute rule, one-on-one direct patient contact, whether the payer has limits to the # of units/time for therapy per day, modality limits, etc. A payer might have made their own guideline regarding whether these are reportable together or not which might differ from NCCI.
The documentation has to be very clear as to what is being performed.

Sounds like you may want to look into a basic PT billing webinar or course (if you're doing outpatient PT?)
Click to expand...
I searched through the on demand webinars and it doesn't look like theres any on PT or OT. Do you know where I can find one?
 
AAPC: https://www.aapc.com/training/physical-medicine-rehabilitation-coding-training.aspx

CMS has a lot of info: https://portal.on24.com/wcc/eh/581986?showId=581986&showCode=PalmettoGBACHNL
The CMS Manual is required reading: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c05.pdf

If your providers are members you can ask to review the information here: https://www.apta.org/your-practice/payment/coding-billing

I haven't watched any of these but there are free ones that might help: https://www.webpt.com/webinars/page/2/
Another resource: https://gawendaseminars.com/past-webinars/
From 2019 but concepts helpful: https://www.aaos.org/aaosnow/2019/oct/managing/managing02/
Not sure about this organization: https://amba.prosperitylms.com/req/amba/_student/index.cfm?prog=9
 
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