Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Article excerpt

Billing for PT services

Our pain management group is considering a merger with a profitable twoprovider physical therapy practice. Before moving ahead, we have two concerns. First, how would we report the PTs' services? Second, the practice's charges are well above the national average-a fact the PTs attribute to hard work, long hours, and multiple locations. Should we be concerned?

First, the coding question: Typically, licensed physical therapists provide services using PT codes 97001-97002 for the workup and evaluation, plus 97010-97028 for the various modalities administered. Each therapist would bill for his own services using the correa codes and his own NPI, attached to the physician corporation's tax ID.

Regarding the unusually high charges, I'd suggest you investigate how their services are administered. If there are only two PTs and multiple sites, it's not possible for them to work at all locations all day, every day. If they're employing physical therapy assistants to provide unsupervised services at other sites, the PTs may be billing inappropriately, at least to Medicare: CMS requires direct supervision by a licensed PT, a physician, a PA, or an NR

Use this injection code

I sometimes give immune globulin injections to patients traveling outside the US. I use the 90281 (immune globulin) code plus 90471 (immunization administration), in addition to the code for the visit, but the administration is always denied. Can you tell me why?

Code 90281 representing immune globulin is not classified as an immunization. Thus, 90471 should not be used to report administration; instead, use 90772 (therapeutic, prophylactic, or diagnostic injection) when there is direct physician supervision. And some insurers bundle injection administration into the E&M service provided on the same date, so even with the correct code, you may continue to get rejections.

Overall service code

When evaluating our allergy patients (many of whom are asthmatic as a result of their allergies), we normally order spirometry (94010). …

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