Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 Terry, Is the observation code being billed by nursing or the physician in the instance you describe? Lane O. Lane, PT, MHSCBL Solutions, Inc.821 Palmetto TerraceOviedo, Florida 32765Tel: Fax: Email: dlane@... CCI Edits Has anyone on the listserve experienced receiving CCI edits when an evaluation code of 97001 is billed with an observation code of 99218? This is occurring when we see an OP after surgery and receive a referral for gait training prior to discharge. We will see the patient and enter charges for an evaluation and gait training. I am now getting an edit indicated as follows: WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and 99218 Standards of medical/surgical practice. I have researched the CCE Modifier Indicator list and see that there is a "0" indicating there is no circumstance in which a modifier would be appropriate. I don't see how they consider our evaluation to be the same as the observation code and the services to be alike. Am I not seeing something here? How much further are we going to be pushed to justify our professional services for payment? Any input would be greatly appreciated. Thanks. Terry Jett MBA,PT Regional Director of Rehabilitation Services Providence Medical Center 8929 Parallel Parkway Kansas City, Kansas 66112-3607 Office: Fax: E-mail: tjett@... Visit our EStore at www.RehabBusiness.comRehab Pro - The software solution to controlling your rehab business! Call to arrange a demo -.Rehab Management Solutions can can improve your bottom line - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 It is a nursing facility applied charge. I am very perplexed by this one. Terry Jett MBA,PT Regional Director of Rehabilitation Services Providence Medical Center 8929 Parallel Parkway Kansas City, Kansas 66112-3607 Office: Fax: E-mail: tjett@... CCI Edits Has anyone on the listserve experienced receiving CCI edits when an evaluation code of 97001 is billed with an observation code of 99218? This is occurring when we see an OP after surgery and receive a referral for gait training prior to discharge. We will see the patient and enter charges for an evaluation and gait training. I am now getting an edit indicated as follows: WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and 99218 Standards of medical/surgical practice. I have researched the CCE Modifier Indicator list and see that there is a " 0 " indicating there is no circumstance in which a modifier would be appropriate. I don't see how they consider our evaluation to be the same as the observation code and the services to be alike. Am I not seeing something here? How much further are we going to be pushed to justify our professional services for payment? Any input would be greatly appreciated. Thanks. Terry Jett MBA,PT Regional Director of Rehabilitation Services Providence Medical Center 8929 Parallel Parkway Kansas City, Kansas 66112-3607 Office: Fax: E-mail: tjett@... Visit our EStore at www.RehabBusiness.com Rehab Pro - The software solution to controlling your rehab business! Call to arrange a demo -. Rehab Management Solutions can can improve your bottom line - Visit our EStore at www.RehabBusiness.com Rehab Pro - The software solution to controlling your rehab business! Call to arrange a demo -. Rehab Management Solutions can can improve your bottom line - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 We only charge for gait as we do not perform a full eval, more like a screen and move right into the functional activities. As far as I know we have not received any such denials. Craig Lee, PT, MS Director of Rehabilitation Services Excelsior Springs Medical Center Excelsior Springs, MO > >Reply-To: ptmanageregroups >To: " 'ptmanageregroups' " <ptmanageregroups> >Subject: CCI Edits >Date: Tue, 3 Oct 2000 14:02:32 -0500 > >Has anyone on the listserve experienced receiving CCI edits when an >evaluation code of 97001 is billed with an observation code of 99218? >This is occurring when we see an OP after surgery and receive a referral >for >gait training prior to discharge. >We will see the patient and enter charges for an evaluation and gait >training. I am now getting an edit indicated as follows: > WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and 99218 > Standards of medical/surgical practice. > >I have researched the CCE Modifier Indicator list and see that there is a > " 0 " indicating there is no circumstance in which a modifier would be >appropriate. >I don't see how they consider our evaluation to be the same as the >observation code and the services to be alike. >Am I not seeing something here? How much further are we going to be pushed >to justify our professional services for payment? > >Any input would be greatly appreciated. >Thanks. > > >Terry Jett MBA,PT >Regional Director of Rehabilitation Services >Providence Medical Center >8929 Parallel Parkway >Kansas City, Kansas 66112-3607 >Office: >Fax: >E-mail: tjett@... > > > > > > _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 Terry & List, I apologize for not being able to locate a reference for my contribution. It is my belief that in the scenario described your post operative case is considered an out-patient unless " admitted " to the facility. Ancillary services such as 97001 or 97116 are officially " bundled " into the principle out-patient surgical procedure. They can not be separately billed. The change was back in about 1995 and I can not find the original documents on short notice. Allan Trumbull Director, Physical Therapy Mount Clemens General Hospital atrumbul@... > CCI Edits > > > > Has anyone on the listserve experienced receiving CCI edits > when an evaluation code of 97001 is billed with an observation code of > 99218? > > This is occurring when we see an OP after surgery and > receive a referral for gait training prior to discharge. > We will see the patient and enter charges for an evaluation > and gait training. I am now getting an edit indicated as follows: > > WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and > 99218 > Standards of medical/surgical practice. > > I have researched the CCE Modifier Indicator list and see > that there is a " 0 " indicating there is no circumstance in which a > modifier > would be appropriate. > > I don't see how they consider our evaluation to be the same > as the observation code and the services to be alike. > Am I not seeing something here? How much further are we > going to be pushed to justify our professional services for payment? > > Any input would be greatly appreciated. > Thanks. > > > Terry Jett MBA,PT > Regional Director of Rehabilitation Services > Providence Medical Center > 8929 Parallel Parkway > Kansas City, Kansas 66112-3607 > Office: > Fax: > E-mail: tjett@... > > > > > > > > Visit our EStore at www.RehabBusiness.com > > Rehab Pro - The software solution to controlling your rehab > business! Call to arrange a demo -. > > Rehab Management Solutions can can improve your bottom line > - > > > > > Visit our EStore at www.RehabBusiness.com > > Rehab Pro - The software solution to controlling your rehab > business! Call to arrange a demo -. > > Rehab Management Solutions can can improve your bottom line - (877) > 552-2996 > > << File: ATT00006.htm >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2000 Report Share Posted October 3, 2000 Terry, I'm sitting here reading the posts regarding your issue and am wondering about the following: If post operatively you can not bill for these services as they are bundeled, why not create a protocol for elective procedures that addresses gait training and home exercise/management planning prior to surgery. There are likely in most surgical cases applicable parameters for pre-surgical PT, and any protocol could address basic requirements/qualifications for pre-surgical PT. I really work very little with p/o patients, and am not certain if there is any validity to my suggestion. Just wanted to post this as a theoretical option, which may have practical use. I look forward to the response of the list. van Well, PT Redford, Mi Terry Jett wrote: Has anyone on the listserve experienced receiving CCI edits when an evaluation code of 97001 is billed with an observation code of 99218? This is occurring when we see an OP after surgery and receive a referral for gait training prior to discharge. We will see the patient and enter charges for an evaluation and gait training. I am now getting an edit indicated as follows: WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and 99218 Standards of medical/surgical practice. I have researched the CCE Modifier Indicator list and see that there is a "0" indicating there is no circumstance in which a modifier would be appropriate. I don't see how they consider our evaluation to be the same as the observation code and the services to be alike. Am I not seeing something here? How much further are we going to be pushed to justify our professional services for payment? Any input would be greatly appreciated. Thanks. Terry Jett MBA,PT Regional Director of Rehabilitation Services Providence Medical Center 8929 Parallel Parkway Kansas City, Kansas 66112-3607 Office: Fax: E-mail: tjett@... Visit our EStore at www.RehabBusiness.com Rehab Pro - The software solution to controlling your rehab business! Call to arrange a demo -. Rehab Management Solutions can can improve your bottom line - (877) 552-2996 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 , Sure, this can be and is often done pre-operatively. Reimbursement is still often " bundled " . The advantage of pre-op, is that one can control the " urgency " factors a little. Allan Trumbull Director, Physical Therapy Mount Clemens General Hospital atrumbul@... > Re: CCI Edits > > Terry, > > I'm sitting here reading the posts regarding your issue and am wondering > about the following: > > If post operatively you can not bill for these services as they are > bundeled, why not create a protocol for elective procedures that > addresses gait training and home exercise/management planning prior to > surgery. There are likely in most surgical cases applicable parameters > for pre-surgical PT, and any protocol could address basic > requirements/qualifications for pre-surgical PT. > > I really work very little with p/o patients, and am not certain if there > is any validity to my suggestion. Just wanted to post this as a > theoretical option, which may have practical use. I look forward to the > response of the list. > > van Well, PT > Redford, Mi > > Terry Jett wrote: > > > > > > > Has anyone on the listserve experienced receiving CCI edits when an > > evaluation code of 97001 is billed with an observation code of 99218? > > > > This is occurring when we see an OP after surgery and receive a > > referral for gait training prior to discharge. > > We will see the patient and enter charges for an evaluation and gait > > training. I am now getting an edit indicated as follows: > > > > WARNING: CCI CONFLICT WITH HCPCS CODES 97001 and 99218 > > Standards of medical/surgical practice. > > > > I have researched the CCE Modifier Indicator list and see that there > > is a " 0 " indicating there is no circumstance in which a modifier would > > be appropriate. > > > > I don't see how they consider our evaluation to be the same as the > > observation code and the services to be alike. > > Am I not seeing something here? How much further are we going to be > > pushed to justify our professional services for payment? > > > > Any input would be greatly appreciated. > > Thanks. > > > > Terry Jett MBA,PT > > Regional Director of Rehabilitation Services > > Providence Medical Center > > 8929 Parallel Parkway > > Kansas City, Kansas 66112-3607 > > Office: > > Fax: > > E-mail: tjett@... > > > > > > > > > > > > Visit our EStore at www.RehabBusiness.com > > > > Rehab Pro - The software solution to controlling your rehab business! > > Call to arrange a demo -. > > > > Rehab Management Solutions can can improve your bottom line - (877) > > 552-2996 > > << File: ATT00001.htm >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2000 Report Share Posted October 4, 2000 Can you please share the solution you came up with??? Loser, PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2000 Report Share Posted November 22, 2000 Assuming this is a Medicare patient, are your observation unit patients considered by Medicare an admission? Jim Dunleavy PT, MS Quote Link to comment Share on other sites More sharing options...
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