Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other

Regards,

Tom Kane, PT
MediGraph Software

Billing for self care/home management and therapeutic activities on the same day
5/24/2011 4:30:00 PM

CPT code 97535 for self care/home management is often considered a component of the more comprehensive code, therapeutic activities (CPT code 97530).  Many therapists incorrectly assume that these two activities cannot be billed on the same day.   Both interventions may be provided on the same date of service and can be billed to your Medicare contractor. To be reimbursed for CPT code 97535, you would have to append modifier-59 to CPT code 97535 on the claim form.  As always, your documentation must support the medical necessity of both interventions and that the interventions were provided at separate and distinct times from each other. 

For modifier 59 please remember that two therapy interventions may not be reported in the same 15 minute period (except for supervised modalities 97010-97028) with other services rendered.  Also recall that:

  1. Two timed procedures (i.e. group and individual) performed in separate time increments, apply Modifier 59. The time calculation rules apply.

  2. Modifier 59 is not appropriate for re-evaluation (97002, 97004) and planned therapy during the same day/encounter.

  3. Apply Modifier 59 for a change in the patient’s condition causing medical necessity
Provide and use Modifier 59 for separate time periods only.   Take extra precautions to document the time period that each service was provided. For example, 9:00AM-9:30AM theapeutic exercises of (list exercises), followed by 9:45AM-10:15AM, aquatic therapeutic exercises (list the exercises).  The words "followed by"  informs the Medicare contractor that you provided  land-based exercises followed by aquatic therapy.  Do not assume that the Medicare contractor will know or ''Figure things out."  Make it easy for them to pay you by elininating their judgement, and or creating extra work for the contractor.  

Regards,

Tom Kane, PT
MediGraph Software