Author Topic: CODING-PHYSICAL THERAPY  (Read 1335 times)

CALI

  • Newbie
  • *
  • Posts: 24
CODING-PHYSICAL THERAPY
« on: September 19, 2012, 05:23:07 PM »
Hello,
We are trying to get payment from United Health Care for an initial consultation for Physical Therapy visits.

We haven't gotten paid for a (init. consult) 97001 with codes 97140 and 97110. 

Is there another code that we can use for the initial consult with the other CPT codes that UHC would pay for?

OR

Should we use a 25 modifier on the 97001 that will identify it as a different procedure?

Any suggestions?

Thank you

CALI

  • Newbie
  • *
  • Posts: 24
Re: CODING-PHYSICAL THERAPY- cali clarifies coding please read
« Reply #1 on: September 19, 2012, 05:26:49 PM »
Let me be clear about the 97001 code- I meant for an evaluation.

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: CODING-PHYSICAL THERAPY
« Reply #2 on: September 19, 2012, 05:41:48 PM »
-25 is the appropriate modifier for the E/M on the same day as services.  This identifies it as significant, separately identifiable e/m service.

bumbleb

  • Newbie
  • *
  • Posts: 29
Re: CODING-PHYSICAL THERAPY
« Reply #3 on: September 20, 2012, 07:23:29 AM »
I bill for PT, but we do not accept United so I am not very familiar with them. 
However, some ins co will only pay for one eval (97001) in a set amount of time. One ins co will pay once every 18mo! even if it is a different problem, and by law the PT has to do the eval! Others will only pay for the eval on the first visit and no other treatment. 

Normally, you would not need a modifier if you only charged the 3 units. If you charge more than 4 units (for example 2-97140 and 2-97110 plus 97001), many ins will only pay for the cheapest 4.  I would call United and see what they say.

Good luck