Author Topic: Pediatric Occupational Therapy  (Read 1321 times)

malinka

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Pediatric Occupational Therapy
« on: October 23, 2016, 04:31:06 PM »
Hi, there just looking for some advice on how to submit an electronic claim for Pediatric Occupational Therapy (Blue Cross Blue Shield).

The session lasts 45 minutes. 97530 is the procedure code and diagnosis code is 97003 (therapeutic activities). Should I submit 3 units and charge for all three units? Or enter 3 units and show charge amount for just one unit?

Thanks in advance, looking forward to hear from someone who is familiar with OT billing.

Michele

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Re: Pediatric Occupational Therapy
« Reply #1 on: October 24, 2016, 07:53:42 AM »

The session lasts 45 minutes. 97530 is the procedure code and diagnosis code is 97003 (therapeutic activities).
97003 is for the evaluation.  This is not a diagnosis code.  I'm thinking you knew that but I wanted to make sure.



Should I submit 3 units and charge for all three units? Or enter 3 units and show charge amount for just one unit?


If the therapist did 3 units you should charge for 3 units.  You should be billing whatever services were performed.

Just out of curiosity why were you thinking you should only charge for one unit?
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malinka

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Re: Pediatric Occupational Therapy
« Reply #2 on: October 24, 2016, 09:23:51 AM »
I meant 97530 code for the therapeutic activities. Thanks for pointing out, Michele!

I thought we were supposed to show how much we charge per unit, and seeing 3 units they would do the math and pay for 3 units. Again I am very new at this. Thank you for your response. I will put the amount for 3 units from now on.

I actually have done that (charged for 3 units) but BCBS paid half of the original amount I put in and then after few days reduced it to even lesser amount.

That is what got me confused a little.

Michele

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Re: Pediatric Occupational Therapy
« Reply #3 on: October 24, 2016, 12:44:46 PM »
OK, that makes more sense!  Say for example the provider charges $50 per unit and does 3 units.  The bill will show a charge of $150 with 3 units.  Then they know that each unit is $50.  They will not multiply so if you bill $50 with 3 units they will think each unit is $16.67.

When you get an EOB you need to make sure they considered the number of units.  Sometimes they get the units wrong and you will notice on the EOB that they only allowed 1 unit when multiple units were indicated.  In either case if you believe the reimbursement is wrong, give them a call and ask them to go over it with you.

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malinka

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Re: Pediatric Occupational Therapy
« Reply #4 on: October 24, 2016, 02:43:31 PM »
Thanks for your guidance, Michele!!! I called BCBS and they've made some corrections!! So happy  :)

Michele

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Re: Pediatric Occupational Therapy
« Reply #5 on: October 25, 2016, 10:46:10 AM »
 ;D
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malinka

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Re: Pediatric Occupational Therapy
« Reply #6 on: October 26, 2016, 10:22:25 PM »
I have another question.

How do you bill if there is 1 unit of 97110 and 2 units of 97530 in the same session ? Am I supposed to use a modifier?


Michele

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Re: Pediatric Occupational Therapy
« Reply #7 on: October 27, 2016, 07:47:03 AM »
I'm going to assume that you are not a coder.  With that being said you should not be adding any modifiers from a billing standpoint.  I understand your question but I want to make sure you know that as a biller it is not ok to add a modifier simply to get a service paid. 

With that being said, it is ok to check with the provider or the coder (someone who has access to the patient's chart/notes) and ask if a modifier is appropriate.  The 59 modifier is often used with PT codes when services are performed during the same session but again ONLY if appropriate, meaning that the patient's chart/notes shows that the services were separate.

If a biller simply adds the 59 modifier to get the service paid and then an audit is done and the notes do not support that modifier the biller and/or the provider can be in trouble. 
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malinka

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Re: Pediatric Occupational Therapy
« Reply #8 on: October 27, 2016, 09:47:53 AM »
Thank you, Michele. No, I am in no position to code anything. Thank you for clarification and the useful information on modifier 59. There is so much to learn from experienced billers like you here.  I will check with the provider.

Michele

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Re: Pediatric Occupational Therapy
« Reply #9 on: October 28, 2016, 07:52:37 AM »
Just wanted to make sure you knew that.  Most billers do not, or they forget.  Our mindset is "make sure everything gets paid" which is good except that we need to make sure we aren't altering anything to do that.  I know when I first started I thought the same thing.  I just like to make sure billers, especially new ones, know about adding modifiers.  :)
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malinka

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Re: Pediatric Occupational Therapy
« Reply #10 on: October 28, 2016, 05:09:06 PM »
Thank you and I appreciate your help  :-*!