Medical Billing Forum
Billing => Facility Billing => : ksteele44 August 16, 2012, 06:04:43 PM
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We are a physical, Occupational, and Speech therapy clinic. We offer our patients the ability to get all 3 services at the same time. When we bill all 3 services a certain company will deny the PT and OT and just pay the speech. We bill on UB's (we are credentialed as an outpatient facility) We typically bill PT using 97110 (with the appropriate revenue code 420), OT using 97530 (with the appropriate revenue code 430), and speech using 92507 (using revenue code 440). Insurance will pay PT and OT together fine, just not PT and Speech; OT and speech; or PT, OT, and speech. How can I fix these claims to get them to pay for these services so the clients can just come on one day.
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You can't code in order to get them paid, what is the denial you are getting, it might be that they just won't pay for more than one therapy per visit, it's like that with mental health therapy as well.
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This is the denial I get:
This procedure is considered part of the primary procedure and is limited by this member's plan.
The ins denies the PT(97110) and OT(97530) and pays the speech(92507). If I bill PT(97110) and OT(97530) claims together that is OK. So it is something with the Speech (92507) and the other codes (97110 and/or 97530).
I have read about possibly using modifiers -25 or -59 Would they be appropriate?
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This procedure is considered part of the primary procedure and is limited by this member's plan.
So they are using that denial code for the 92507 line?
I'm thinking a modifier isn't going to help because they are saying the patient is limited to two types of therapy on one day (JUST A GUESS) you should contact them to find out.
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I don't think the modifier will help either. You should contact the company. It doesn't sound right that they would say that the PT and OT are part of the ST, as they are obviously very different services. It may be a system error on their part and may not be anything you are doing at all.