Wiki CPT code 97545

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monica lanning

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I believe that this WC carrier is incorrect, but I can't really find any information to support their denial. CPT code, 97545, states initial 2 hours in the CPT book. They are denying our services because the therapist only spent about 1 hour and 15 minutes. We have never had any issues billing this code, until today. Would anyone be able to provide me any feedback.

Thanks so much!

Monica L
 
Monica & Lauren,
What was the first dx code or list of dx codes used linked to CPT 97545? Did add right modifiers of GO or GP and 96 or 97 depending on documentation. See list of modifiers in CPT manual. Also did you put referring doctor down or if pt had other phys therapist visit same month or month before? Does it need authorization on it from payer? Work hardening must have been related to wheel chair management OR job related injury but not more than 120 minutes. Did you know term work hardening is a therapeutic procedure used by physical and occupational therapists to help patients return to work after a work-related injury ? It can include vocational training and the use of simulated or real work activities.
I hope helped you
Lady T
 
monica lanning said:
I believe that this WC carrier is incorrect, but I can't really find any information to support their denial. CPT code, 97545, states initial 2 hours in the CPT book. They are denying our services because the therapist only spent about 1 hour and 15 minutes. We have never had any issues billing this code, until today. Would anyone be able to provide me any feedback.

Thanks so much!

Monica L
Click to expand...
Monica,
What was the first dx code or list of dx codes used linked to CPT 97545? Did add right modifiers of GO or GP and 96 or 97 depending on documentation. See list of modifiers in CPT manual. Also did you put referring doctor down or if pt had other phys therapist visit same month or month before? Does it need authorization on it from payer? Work hardening must have been related to wheel chair management OR job related injury but not more than 120 minutes. Did you know term work hardening is a therapeutic procedure used by physical and occupational therapists to help patients return to work after a work-related injury ? It can include vocational training and the use of simulated or real work activities.
I hope helped you Lady T
 
TThivierge said:
Monica & Lauren,
What was the first dx code or list of dx codes used linked to CPT 97545? Did add right modifiers of GO or GP and 96 or 97 depending on documentation. See list of modifiers in CPT manual. Also did you put referring doctor down or if pt had other phys therapist visit same month or month before? Does it need authorization on it from payer? Work hardening must have been related to wheel chair management OR job related injury but not more than 120 minutes. Did you know term work hardening is a therapeutic procedure used by physical and occupational therapists to help patients return to work after a work-related injury ? It can include vocational training and the use of simulated or real work activities.
I hope helped you
Lady T
Click to expand...

The primary dx is S39.012A. Billing with modifier GO. This IS a workers comp claim. Many dates of service have been paid, but those are the dates of service with documentation stating treatment was 120 mins. The visits in question are several dates that have WH treatment of 75-90 minutes. The carrier is stating that since this is less than 2 hrs, it should be billed with different CPT. I understand this, as the code description just states "initial two hours", not "up to two hours", but I can't find any official reference online confirming this.
 
Lauren423 said:
The primary dx is S39.012A. Billing with modifier GO. This IS a workers comp claim. Many dates of service have been paid, but those are the dates of service with documentation stating treatment was 120 mins. The visits in question are several dates that have WH treatment of 75-90 minutes. The carrier is stating that since this is less than 2 hrs, it should be billed with different CPT. I understand this, as the code description just states "initial two hours", not "up to two hours", but I can't find any official reference online confirming this.
Click to expand...
Lauren
How hurt back per dx S39.012A? I would add that...lifting, fell at work see dx blocks of W18, W01, W11, W22 & where? . They may deny cause cap dates on WC treatment may need to do another authorization if pt need MORE sessions. Did use SAME dx code for problem WC injury authorized by WC payer and same provider authorized by WC payer? Did add where injury happened & how and date it happened on claim? See dx blocks Y92.6 factory or Y92.5 grocery store or y92.23 hospital...need to add this since initial injury.
The CPT code is one 97545 visit for 120 minutes or close to it, next day treatment or more minutes new CPT code.. not add all up differ visits to get 120 minutes.
I hope helped you. Oh yes Happy New Year 2025 too
Lady T
 
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