Medical Billing Forum

Coding => Coding => Topic started by: mlambert1010 on November 07, 2013, 09:48:11 AM

Title: Modifiers for PT
Post by: mlambert1010 on November 07, 2013, 09:48:11 AM
Since Medicare has deleted the 59 modifier, what modifier do you use for unbundling - distinct procedure.  Also, what modifier is used with 97001-97002?
Title: Re: Modifiers for PT
Post by: shanbull on November 21, 2013, 02:34:16 PM
I am still getting claims paid by Medicare with the 59 modifier. Are you aware of the new PT functional limitation coding requirements? The denials for claims without them are rejected for "this procedure is not payable unless non-payable reporting codes and appropriate modifiers are submitted" so that may be where you're getting the idea that the 59 modifier is invalid. It's still ok to use, you just need additional coding on evaluation claims, discharge claims, and every 10th visit. Every claim in these categories requires two G-codes and each of the G-codes requires two modifiers (one for professional level and one for the functional limitation percentage).

Here is the best guide I've found for the new coding: (

Obviously these codes involve medical decision-making so the PT providers need to be familiar with the codes and deciding which ones are appropriate for the claims, even if they aren't doing the coding themselves. This is not a situation where you can select the codes.