99211

[Guest guest]

Is anyone still charging a 99211 for OV when allowed by the insurance

company?

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[Guest guest]

At this time the coding for the evaluation of an established patient should

be done using the evaluation codes developed for use by physical therapists

( 97001 and 97002). Perhaps you should contact the insurance carrier to

determine which version of the CPT coding manual they are using. There are

three reasons for this suggestion.

#1 The PT evaluation codes were introduced in January 1998 and are used by

payors across the country, including Medicare. I don't have a copy of the

Medicare fee schedule for E & M services but code 97002 may reimbruse at a

slightly higher rate.

#2 If the carrier is not requesting that you use the PT eval codes this may

indicate their use of an older version of the CPT coding system. The result

is that you may be coding your bills using the new manual therapy code (CPT

97140) which the carrier does not recognize. The means your bills for that

service may be denied or recoded by the payor to a to a lower level code in

their system.

#3 The APTA, primarily through the strong efforts of Helene Fearon, Steve

Levine and Jim Nugent, developed these codes for use by PTs. Some states

have a significant portion of payors and self-insureds that do not believe

PTs should perform evaluations (the doctor already did an evaluation - why

do you need to do one?) and the use of these codes in Medicare and private

health systems reinforces the professional role of the physical therapist in

health care.

Bill Hutchins

Team Spinnaker, Inc.

Physical Therapy Centers wrote:

> Is anyone still charging a 99211 for OV when allowed by the insurance

> company?

>

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