Billing > Billing
Pediatric Occupational Therapy
malinka:
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:
--- Quote from: malinka on October 23, 2016, 07:31:06 PM ---
The session lasts 45 minutes. 97530 is the procedure code and diagnosis code is 97003 (therapeutic activities).
--- End quote ---
97003 is for the evaluation. This is not a diagnosis code. I'm thinking you knew that but I wanted to make sure.
--- Quote from: malinka on October 23, 2016, 07:31:06 PM ---Should I submit 3 units and charge for all three units? Or enter 3 units and show charge amount for just one unit?
--- End quote ---
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?
malinka:
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:
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.
malinka:
Thanks for your guidance, Michele!!! I called BCBS and they've made some corrections!! So happy :)
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