Author Topic: PIP billing - maximum allowable codes?  (Read 1500 times)


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PIP billing - maximum allowable codes?
« on: March 08, 2012, 09:27:14 AM »
I am billing for a chiropractor's office and they have done a re-exam for a PIP patient. Is there a maximum number of CPT codes we can bill on one visit? We usually bill 4-5 but for this particular day, we have 6. I just don't want to cause any alerts with such a high number. Also, is there a requirement to have a new set of diagnostic codes following the re-exam?

Appreciate any help here!


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Re: PIP billing - maximum allowable codes?
« Reply #1 on: March 08, 2012, 10:23:47 AM »
Be sure your documentation supports the re-exam and use modifier -25 to indicate it's a separate service.  I don't think there is a max number of procedures you can BILL, but there may be a max number that the insurance will PAY.  In the Worker's Comp arena there is a cascade (they reduce the allowed by 25% per procedure to a max of 4 procedures).

I'm curious WHY there are so many procedures in one visit, but I realize that each practice is different. On a re-exam day you may just want to do the exam PRIOR to any therapies or modalities and adjustment.  The ROM's will be more accurate.  The dx codes may not change, but if portions of the injury have resolved, that should be noted in the record and on the report (if one gets generated for the re-exam).