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Pediatric Occupational Therapy

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Michele:
 ;D

malinka:
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:
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. 

malinka:
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:
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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