Author Topic: Physical Therapy Billing Changes  (Read 1017 times)

Ultraserve

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Physical Therapy Billing Changes
« on: September 23, 2010, 04:47:24 PM »
Hello,

Does anyone know about any changes to Physical Therapy CPT Code 97112 (neuromuscular reeducation of movement, balance, coordination etc)??

I billed BCBS for this CPT code 97112 with the following ICD-9 codes V54.81, V4365, 7812, 71946 with supported modifier GP and KX, since the patient had a R. TKA done. But BCBS denied this specific diagnosis codes as invalid to the CPT codes. I normally use these codes for TKA's. Please If there are any changes please help me because I can't find anything or changes. I used Medicare supported ICD-9 codes for specific CPT codes.

Thank you all for the help in advance.

Michele

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Re: Physical Therapy Billing Changes
« Reply #1 on: September 23, 2010, 07:46:36 PM »
I am not 100% sure, but I always thought that the actual diagnosis for the reason they had the joint replacement was used primary, and the V code was secondary. 
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Ultraserve

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Re: Physical Therapy Billing Changes
« Reply #2 on: September 24, 2010, 07:51:36 AM »
that's how it was but if using modifiers KX, thats the order it goes. so are this valid diagnosis for the CPT 97112?

DMK

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Re: Physical Therapy Billing Changes
« Reply #3 on: September 24, 2010, 10:19:47 AM »
You may want to go on the CMS site and look at the LCD codes.  CMS is pretty specific about what codes to use and in what order, and what codes constitute medical necessity.

Ultraserve

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Re: Physical Therapy Billing Changes
« Reply #4 on: September 24, 2010, 01:27:27 PM »
Thank you DMK, i have looked at the LCD'S and the diagnosis are listed, I dont know if BCBS has a different guidelines somewhere that no one can find.

Thank you both for your input. Any new suggestion or ideas is still welcome.

DMK

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Re: Physical Therapy Billing Changes
« Reply #5 on: September 24, 2010, 04:00:44 PM »
I'm such an idiot!  You're not billing Medicare!  I saw the modifiers to the DX and automatically thought Medicare. 

You would want to put the condition or problem you're working on (gait disturbance? 781.2) and then the status post surgical.  If there is an EM code being billed on the same day, then you would need to add -59 to the 97112 to show it was a separate service.

Hope that helps!

Dina