Wiki Home Health Therapies Same Day (Modifier?)

[davataf2]

Hi everyone!

I am coding some home health therapies (Speech and Occupational Therapy). The services happened on the same day but one in the morning and one in the afternoon by a different therapist. I added modifier 59 to the occupational therapy as it happened later in the day. Should both therapies have the modifier and is 59 the best modifier to use?

 

[TThivierge]

Hi Davataf2,
However modifier 59 might be best bet if differ treatments done same day. Sounds good. Since parts of body being manipulated & or massaged vs speech vs occupational muscles )or Etc. Is it same body area massaged or speech for the 2nd visit? Or check out modifier KX...it means medical necessity because process being done again. Id put modifier59 on CPT done later in the day not both.....that be confusing for payer. Id sent cover letter explaining the situation or make comment when processing claim. However but also use differ modalities signify by modifier of GO or GP. Does the payer want these modifiers of GO or GP and referring doctor name on claim? Also minutes must be in day s treatment documentation too.
I hope helped you
Lady T

 

[davataf2]

Hi Davataf2,
However modifier 59 might be best bet if differ treatments done same day. Sounds good. Since parts of body being manipulated & or massaged vs speech vs occupational muscles )or Etc. Is it same body area massaged or speech for the 2nd visit? Or check out modifier KX...it means medical necessity because process being done again. Id put modifier59 on CPT done later in the day not both.....that be confusing for payer. Id sent cover letter explaining the situation or make comment when processing claim. However but also use differ modalities signify by modifier of GO or GP. Does the payer want these modifiers of GO or GP and referring doctor name on claim? Also minutes must be in day s treatment documentation too.
I hope helped you
Lady T

Hi! Thank you so much!

The referring provider is on the claim but the services were sent out as two different claims. We are using G0153 (ST) and G0152(OT) so would we need the GO/GP to distinguish?

 

[TThivierge]

Hi! Thank you so much!

The referring provider is on the claim but the services were sent out as two different claims. We are using G0153 (ST) and G0152(OT) so would we need the GO/GP to distinguish?

Hi Davataf
The commercial payers tell us to add these modifier G0 and GP to distinguish occupational treatments done by therapist. Also modfiier GN means speech therapy. Also these modifiers are in the HCPCS manuals in back, Appendix 2. Usually G codes are for the Medicare payer.
Well hope helped you
Lady T

 

[davataf2]

Hi Davataf
The commercial payers tell us to add these modifier G0 and GP to distinguish occupational treatments done by therapist. Also modfiier GN means speech therapy. Also these modifiers are in the HCPCS manuals in back, Appendix 2. Usually G codes are for the Medicare payer.
Well hope helped you
Lady T

Hi TThivierge,

Thank you so much for answering. These claims are being sent to Medicaid. Unfortunately we received a NCCI denial even with the modifier 59. I am going to resubmit and try XE.