Author Topic: PT, OT - same patient, same DOS, same provider group  (Read 1094 times)


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PT, OT - same patient, same DOS, same provider group
« on: February 17, 2009, 12:28:45 PM »
Been getting denials on claims when a patient has physical therapy and occupational therapy on the same dates of service. Sometimes OT and PT use same codes also.  the tax ID is the same and group NPI is the same for these claims.  But I put the rendering PT or OT NPI in box 24J and put name of the rendering provider in box 31.  The denials say "already processed this charge".  I've sent in reconsiderations w/ notes but some are still denied.  Was wondering if there's something else I should put on the claim, maybe a modifier or something to show which type of therapy the claim is for.  Ins. carrier suggested sending in notes w/ each claim, but I submit claims electronically and cannot send attachments w/ the service I use.  Notes have to be faxed or mailed separately.  Also, would have to get my providers to send notes in w/ each set of new charges.  So before asking them to do that, would rather see if there's something I can do on the claim. 
Also, these patients are Medicaid secondary - I can't file the secondary with a denial EOB saying "already processed".  That sounds like it's a duplicate claim, which is isn't.   Thanks,  ryanne


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Re: PT, OT - same patient, same DOS, same provider group
« Reply #1 on: February 17, 2009, 01:41:50 PM »
I feel for you.  I had the same situation a couple years ago and it was a mess.  There is no fix.  You can try using the 59 modifier but it doesn't usually do any good either.  I had to submit the claims, get the denial, then appeal.  I had a form letter specific to this situation that I attached explaining that it was PT and OT, spelled out the diagnosis, and renderning provider info and then they would reprocess and pay correctly. 

Maybe somebody else has had this situation but has another suggestion.

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