Medical Billing Forum
Coding => Coding => : electrobills January 13, 2010, 12:07:41 AM
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I have been billing for a speech therapist. She usually does a 92507, 92526, 97532 and 97533. Can anyone explain to me why she isn't getting paid for both codes together? When I do either one on its own it gets paid. Do I need a modifier 59 or is it something else?
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I'm a little confused because you listed 4 codes, but said "she isn't getting paid for both codes together". I'm not sure if you meant all 4 codes together, or that only 1 code gets paid and 3 get denied. Anyway, I'm wondering on the 97532 & 97533 codes, since they are listed in the Physical Medicine section, if they are considering those outside the scope of practice. Really to help I would need to know the exact denial reasons.
Thanks
Michele
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Sorry, I guess I wasn't too coherent. The 97532 and 97533 are being denied from Oxford with a TCOD - the service is ineligible for reimbursement as a separate procedure. Some of the 92520s are being denied for the same reason and some are being paid. BCBS is denying with a U749 - basically the same thing.
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From what you are describing it sounds like it is a contract exclusion. If that is the case, a modifier will not help. If the provider states the 59 modifier would be appropriate for the services you can try it.
Michele
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I do billing for speech, OT and PT. I don't think the 97532 or 97533 codes are within the scope of practice for speech therapists. I have billed them for my PT's and OT's, but never any of my speech therapists. A really good source of information is the ASHA website. (American Speech Language and Hearing Association) If your therapist is a member you can find lots of information regarding coding, billing and reimbursement issues. www.asha.org.
Stephanie