Wiki helpppp...dx coding for physical therapy

[blnord]

Hi all,
I am a billing service and specialize in physical therapy. I need some clarification, I am NOT a certified coder and have recently notified my providers that I would not affix an ICD9 code to a claim that they needed to send me the correct code along with the patient info (previously they would send me a copy of the referring doctors script with the written diagnosis only). I told them that because I am not a coder it is not legal for me to be doing this one of my providers is disputing that, he says:
" I can see this for an MD. You have to remember we are not attaching any diagnosis, by the time the patient sees us the diagnosis has been made and is in the system. We cannot do anything to change that. If we were the ones making the original diagnosis I could understand. There is no illegality here because we are working with the doctor's diagnosis. Whether we put the ICD-9 code down or you do it, how does it matter? We do not have a certified coder on staff either. Doctor's do, but we don't because we do not need one. It would be redundant and a waste of time. I have confirmed this with a friend of mine who has a PT billing company."
Can anyone corroborate either way which is true?

 

[mitchellde]

The diagnosis that most physician offices affix to the PT order are not the correct ones to use for PT. For instance if the patient had degenerative joint disease and had a knee replacement the diagnosis for rehab is not the DJD. The coding guidelines will walk you thru this and for ICD-9 the first listed code for rehab must be the V57 code, for PT this would be V57.1 as first listed followed by the reason for rehab. For PT following joint replacement due to DJD you would use say gait instability as the second dx and the V45 code for the joint replacement status. If it is for PT following a fx you would use the V57.1 first, the need for the rehab such as muscle atrophy second and the 905 code for late effect of fracture.
For ICD-10 Cm this will change as there is no equivalent code to the V57.1. So you will code first list the reason for rehab.
No you do not have to be a certified coder to determine the correct code (not yet). As the one that enters the code, even if supplied by the provider, you are still liable for the code you enter.

 

[kslade1]

PT diagnosis Billing

I agree with Ms. Debra I am a CPC who bills outpatient therapy private facility and outpatient hospital. The referring MD almost never has the correct dx for therapy. They will give you "Hip replacement" (with date), DJD, Osteoarthritis, etc. per coding guidelines the V code for physical therapy is always first reported, in most cases Im coding the pain associated to DJD, or pain associated with post surgical procedures, or the late affect of a surgery or accidental injury

 

[blnord]

Thank you for the input, I am still really confused as I am still getting such conflicting information I agree that what the referring Dr. gives as a DX is not always the correct one I just need to know if it is ok for me to put 719.46 on a claim if the therapist tells me the DX is knee pain (for example). I was told that that is interpreting a narrative which I can't do because I am not a coder but how would a biller working directly in the office handle it? I just want to do what is correct and not something that can come back to bite me.