Coding > Coding

I need to know if I need a modifier code?

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best biller:
which of the following modifiers would i use if the provider is an internal medicine for procedure 97112,(GO,GP or GN)?

shanbull:
GP, because it's delivered under a physical therapy plan of care (both MD's and PT's are covered under this category). GO is for occupational therapy and GN is for speech pathology therapy. Depending on the insurance plan/state rules you may also need to include a professional level modifier for higher reimbursement  (in which case the most appropriate modifier would be AG), but I would try to bill without it first, especially if you don't usually need to use a modifier for physician services.

Merry:
And do check with Medi-Cal. You can see if you can speak to someone who works on therapy claims. Medi-Cal marches sometimes to their own music. Do check with the provider manual or call them for clarification.
http://tinyurl.com/mmoukjr If you copy and paste this url in your browser, you will get the manual for PT for Medi-Cal. Scroll down as there is so much info here. You would use GP modifier but you need to see what else they require.

Hope that this helps.

Merry

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