![]() ![]() The National Correct Coding Initiative (NCCI) has identified procedures that therapists commonly perform together and labeled these “edit pairs.” Thus, if you bill a CPT code that is linked to one of these pairs, you’ll receive payment for only one of the codes. So, how does modifier 59 come into play in the therapy setting? If you’re providing two wholly separate and distinct services during the same treatment period, it might be modifier 59 time. But that’s because modifier 59 is intended mainly for surgical procedures, so the definition leans a great deal that way. That explanation is a bit dense, and it’s not super relatable. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.” However, when another already established modifier is appropriate, it should be used rather than modifier 59. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. Modifier 59 is used to identify procedures services that are not normally reported together, but are appropriate under the circumstances. ![]() “Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. The CPT Manual defines modifier 59 as the following: Please note that while some Medicaid programs, commercial payers, and Medicare Advantage payers may follow suit, this change does not necessarily affect them, so be sure to reach out to your other payers to determine where they stand. Update: Beginning July 1, 2019, CMS will unbundle NCCI edit pairs when providers attach the appropriate modifier (59, XE, XS, XP, or XU) to either the first-column or second-column code (assuming, of course, that the situation warrants the use of one of these modifiers). Remote Evaluation of Images and Recorded Videoįor more details on these codes-including payer coverage and required modifiers-download this free Telehealth Billing Quick Guide for PTs, OTs, and SLPs. Online Digital Evaluation and Management Services Outside of “true” telehealth-and based on temporary, crisis-related regulatory provisions-therapists may bill the following codes when providing remote patient care: In most cases, therapists bill for “true” telehealth services using the same CPT codes they would bill for services provided in the clinic (typically with some type of telehealth modifier affixed to the claim, per the individual payer’s guidelines). In light of the COVID-19 pandemic, CMS and many commercial payers began allowing rehab therapists to provide and bill for certain remote care services. Which CPT codes should PTs, OTs, and SLPs use to bill for remote and virtual care services? Then, you might complete standard canalith repositioning on your patient, in which case you would include CPT procedural code 95992 on your claim. Here is an example of ICD-10 and CPT codes in use: today, if you diagnose a patient with “Benign paroxysmal vertigo, bilateral,” you would use the ICD-10 code H81.13 to indicate your diagnosis. In short, CPT codes are procedure codes and ICD-10 codes are patient diagnosis codes. What’s the difference between ICD-10 and CPT codes?Īs mentioned in the intro above, while CPT codes are similar to ICD-10 codes in that they both communicate uniform information about medical services and procedures, CPT codes identify services rendered rather than diagnoses. What are the most common physical therapy CPT codes?īelow are the 20 top CPT codes recorded within WebPT between September 2019 and February 2020: 97110Įlectrical Stimulation, Medicare Non-Wound (Unattended)ĬPT codes are copyright 1995-2020 American Medical Association. The difference is that on claim forms, CPT codes identify services rendered rather than patient diagnoses. Like ICD codes, CPT codes communicate uniform information about medical services and procedures to healthcare payers. ![]()
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