Medical Billing Forum
General Category => General Questions => : Chell5 February 27, 2009, 05:17:12 PM
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What is the difference between 97001 and an E/M consultation? Also, am I correct that 97002 done when there is a significant change in functioning? Is there a quantity restriction on the number of rechecks? My last question is regarding group therapy. . .is there any restrictions on age of the patients? For example, the pt wants to do group exercised for obese kids. Thanks for your help!
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Hi,
97001 is the cpt code specifically for an initial physical therapy evaluation to evaluate the client’s condition and establishing the plan of care. An E&M code is for the evaluation and management of a medical condition, a medical exam that must meet certain key components. A physical therapist should not be using E&M codes for their initial evaluation since there is a more specific cpt code to indicate the PT initial eval.
As for the 97002, or re-eval, the frequency depends on each individual insurance carriers. Some state you can only do a re-eval once per year. Others have different criteria. There is no universal rule.
For group therapy, I am not aware of any restrictions specifically due to age. Each insurance carrier has their own guidelines (sorry if I sound like a broken record :( ) but usually PT is covered if it is ordered by a physician for a covered medical condition.
Hope that helps you out.
Michele
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It does help. I was hopeful that I could bill an E/M because it is reimbursed so much higher. Thanks for the information.