dballard2004
True Blue
I have a question about ICD-9-CM coding for PT encounters that I would like opinions on, please....
Am I correct that per the ICD-9-CM guidelines, if the patient is presenting for PT and this is the sole purpose of the encounter, you need to report code V57.1 as primary?
I am getting some pushback on this because one of our PTs feels this guidance only applies to the inpatient setting (we are a physician's office) and also we have never billed this code before as we have always just billed the reason for the therapy and we have not been denied from our payers because we have not reported the V57.1 code. Aren't payers required to follow the ICD-9-CM guidelines? I know they have leaway with the CPT rules, but I thought they were required to follow the ICD-9-CM rules due to HIPAA?
Thoughts?
Am I correct that per the ICD-9-CM guidelines, if the patient is presenting for PT and this is the sole purpose of the encounter, you need to report code V57.1 as primary?
I am getting some pushback on this because one of our PTs feels this guidance only applies to the inpatient setting (we are a physician's office) and also we have never billed this code before as we have always just billed the reason for the therapy and we have not been denied from our payers because we have not reported the V57.1 code. Aren't payers required to follow the ICD-9-CM guidelines? I know they have leaway with the CPT rules, but I thought they were required to follow the ICD-9-CM rules due to HIPAA?
Thoughts?
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