DEPARTMENT OF LABOR

[billingsuper]

I am having problems with department of labor paying for PT initial eval when billed with 97110, 97530, 97140.  They are paying all of the procedures but stating that 97161 is inclusive of another code(bundled).  Does anyone know if they usually pay for initial evals with procedure codes?  Is a 59 modifier required?  This is for louisiana WC claim.

[Michele]

I have not billed LA WC in particular, but usually the initial eval is separate.  Normally no modifier is needed.  Are they paying the other codes but denying the 97161?

[billingsuper]

Yes they did pay all of the other codes but they are stating that 97161 is inclusive to 97110.  We did append a 59 modifier on the 97110 but they still denied.

[Michele]

It may be that they don't allow an evaluation with therapy but honestly I have not seen that before.  The evaluation is usually considered separate without any modifiers.  You could try the 25 modifier on the 97161 but it is not usually used for that.