Author Topic: Need help with billing therapy codes 97140, 97110, 97032 and 97035 to FL Medicar  (Read 2919 times)

KARREN

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Senario:
Doctor= D.O.  now doing therapy services on some patients.
He is billing 99213-25, 97140 GP59, 97110 GP 59, 97032 GP, 97035 GP 
Second visits bills 97140 GP59, 97110 GP 59, 97032 GP, 97035 GP 
He has provided dx 723.2, 722.4, 722.52, 728.85
Medicare paid 99213 and denied therapy charges code 50 (lcds) on both visits
I researched LCDs and found only 3 payable dx 457.0, 457.1 and 757.0 for automatic exception to the therapy cap. 
Question:
1)   Should I add the KX modifier in addition to the above modifiers or wait until mc cap is reached?
2)   Can someone please clarify this for me? I am a little confused with the KX modifier, I thought that after Medicare pays the therapy cap then you add the KX modifier to state medical necessity with the appropriate dx codes 457.0,457.1 or 757.0 and  Medicare will pay more on therapy codes.
3)   Does anyone have a list of ICD9 codes that supports Pcode 97140, 97110, 97035, 97035?

Thanks!


Michele

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I'm a little confused.  Are the therapy codes being denied for medical necessity or because the CAP was met?
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KARREN

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Sorry for the confusion. The therapy services denied code co-50 med necessity.  When I reviewed the LCDs it shows only 3 DX that supports med necessity. Are there any others DX that r payable for therapy codes.  I am having problems getting therapy codes paid since the new edits been in place.  When I was billing these therapy codes before mcare use to pay.  Every since the fun report came in effect our mc claims have been denying.  We follow the guidelines reporting the fun limitation with severity mod each 10th visit.

PMRNC

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Quote
Are there any others DX that r payable for therapy codes.  I am having problems getting therapy codes paid since the new edits been in place.

Be careful how you word this.. you can't assign dx codes to procedures just for payment. The diagnosis codes have to be from the medical record.
I normally don't keep listing of covered diagnosis codes for certain procedures and don't advise my clients to either, they assign the diagnosis code that applies from their documentation and this way there is no room for "picking". ;)
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KARREN

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ok thanks.. I am aware that the information must be documented in the records.
 I always have the doctor provide me with the dx codes.. Example dr provides me with dx  723.1,724.2,728.85  claim denies co-50 med ncsty according to lcd and in the chart dx are 723.1,724.2,728.85, 723.2,722.52.    The LCD only list 722.52,  is it ok to ask the doctor are there any more diagnosis that you can provide me with to rebill this claim..   the doctor then reviews chart and provides me with 723.2, 722.52.. then I go ahead and rebill the claim..  isn't it correct to do it that way?

Michele

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There are more than 3 ICD9 codes that are considered medically necessary for the therapy codes you posted, that is why I was questioning the denial.  We do bill those therapy codes, and sometimes with the dxs you mentioned.  I was wondering if the three ICD9 codes you mentioned are only for "over the CAP".
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