what modifiers are appropriate for physical medicine and rehabilitation

[higher standard]

Hello:

When code 97003 (evalution) is billed with 97530 x 2, are modifiers used?

OR what modifiers are appropriate if 97530, 97532 or 97533 are billed together?

Thank you,


Christine Jolitz, CPC

 

[areedy71@yahoo.com]

are you referring to Chiropractic billing?

 

[CodingKing]

are you referring to Chiropractic billing?

Those are OT codes

NO CCI edits between 97003 & 97530

There are some edits between 97530, 97532 & 97533 where modifier 59 may be needed if distinct and separately identifiable.

Payer may have policy against eval and treat on same date of service regardless of modifier use. I'm not sure about other modifiers like GP, GO or GN as I'm not familiar with them

 

[golymom]

therapy modifiers

As stated earlier you have a bundling situation with 97530, 97532 and 97533 in order for the 59 modifier to be appropriate these would each have to be performed in separate 15 minute time periods. Since you are using 97003 for your evaluation code I am assuming the performing provider is OT not PT. You would then also need the GO modifiers on all of the codes if billing Medicare. Some of the commercial plans are also using the GO/GP modifiers. Some are also requiring the 25 modifier be appended to the evaluation to indicate a separately reportable service from the treatment.