Wiki Physcial Therpay question

[AshleyF1985]

I am a physcial therpay coder and we have gotten a huge amount of write offs through Medicare with ANSI code co-59 which states, "Charges are adjusted based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.)"
I do not see a constant thing wrong with these claims, there are no bundling issues, no more 4 modalities are being billed at a time. I am just confused. Does anyone have any insight as to what this could mean i am doing wrong? Does each seperate timed procedure need a modifier -59?
I am so lost on this one any help is appreciated

Ashley

 

[nateich]

depending on the modalities billed, yes a modifier will need to be added. can you give an example of the code submitted?

 

[dclark7]

CMs has a Multiple Procedure Payment Reduction policy for some physical therapy services. You can find out more at the CMS website, but here's a MLN Matters article.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/mm7050.pdf

 

[AshleyF1985]

an example would be 97530 x2 (therapeutic activites, direct pt contact, each 15 min) and 97110 x2 (therapeutic exercises, each 15 min)

 

[nateich]

these codes do not bundle, therefore, -59 is not needed; but Doreen is correct, CMS now reduces PT services based on MPPR; unfortunately there is nothing that can be done except support your local APTA while they are lobbing in Washington to end the reduction on timed therapy codes.