Wiki Need Help with Physical Therapy Billing

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thar1995

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Hello, I need help billing Physical Therapy.
The practice enters the charges and puts GP mod on all items. They said to put a 59 mod on 97112 when it was denied by medicare for B-15 -Service/Procedure requires that a qualifying service/procedure be recieved and covered.
97760 was denied for benefit maximum for time period has been reached.
Original claim had pre-authorized tracking number on it. Medicare forwarded claim to secondary BCBS.
Added 59 to 97112/59/GP, re-filed.

BCBS paid 97760 but not 97112.

Medicare denied both 97112 & 97760 for benifit maximum reached.
Added KX modifier to both 97112/59/KX & 97760/KX.

Medicare denied 97112 for Procedure code inconsistant with modifier used or required modifier is missing.
What is the correct way to bill this, please?
Thanks
 
You need to use an exempt DX code to add a KX. We used to give the therapist a list of exempt icd-9 codes to choose from so that once the patient reached his/her max the KX could be added.
 
Medicare

I found this on a slide show from CMS and NHIC. One of the slides shows this:

Billing – CPT CODES: Not Permitted (Page 7of 14)
Any two CPT codes for "therapeutic procedures" requiring direct one-on-one
patient contact (CPT codes 97110-97762)

Might want to review the modifier 76 with the notes to see if it applies.

Link to slide show below.

http://www.medicarenhic.com/providers/pubs/PartB2011TherapyUpdates061411.pdf
 
I doubt you will never need to use a 76 mod in PT, it doesnt describe this coding issue anyways as this is for a repeat procedure by same physician on same day and neither apply in this case, the only mods we ever use in our office are 59 GP/GO/KX or GA/GZ/GY for ABN info on Medicare claims and this is really only more so recently due to the $3700 threshold auths and being denied sometimes.
You listed only the 59/KX mod when rebilling 97112, did u still submit with the GP mod also or was that just a typo? it will definitley deny if you only resubmitted with those 2 and not the GP in addititon. The only other thing I could think happened is maybe the modifier didnt actually transmit with the claim? check the remit to be certain it was really on the claim, occasionally this happens to us even though I can see it right there in the system on the code. Also keep in mind that BCBS may not pay 97112 if Medicare denied especially for bundling but sometimes wil cover a balance when denied for max benefits so ths could be what happened, its also possible they still consider it experimental i see this quite a bit actually with certain BCBS plans.
 
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