Re: 97110 & 97140 BILLING DENIALS

[Guest guest]

;

I have noticed some disturbing trends with Blue Cross carriers in the

different states that we bill in. Here in Iowa Blue Cross has implemented a

Guide to Physical Medicine. There are no are insurance companies out there

who come close to this guide. Blue Cross has decided that certain codes

cannot be used in conjunction with one another and certain combination of

codes cannot be billed over a certain number of units. I want to temper my

comments somewhat by explaining that I am not a physical therapist and do not

know if these guidelines are unreasonable. However, I do notice a trend and

something DOES NOT SMELL RIGHT.

As an example, you cannot bill more than 2 units of Therapeutic Exercise in a

date of service. Any more than 2 will trigger an automatic denial/medical

review. Also, 2 units of Therapeutic Exercise will nullify your ability to

bill for Therapeutic Activities and Manual Therapy techniques. In other

words, any hands on therapist working with a patient more than 30 minutes is

outside of a norm as determined by BCBS. What is strange is that there

reimbursement starts BELOW the rest of the insurance industry and now they

feel a need to cut reimbursement further. I would encourage you like I am my

Iowa clients to find other providers and begin a dialogue about the

fairness/appropriateness of what they are doing. Make a list and decide if

it is worth pursuing with them. If there will not be an honest dialogue with

your provider rep, you might want to solicit an attorney to determine whether

it would be worth pursuing in the courts.

Jim Hall, CPA <///><

http://members.aol.com/jhall49629

[Guest guest]

HAS ANYONE SEEN DENIAL OF

97110 & 97140 WHEN BILLED TOGETHER? I CONTINUE TO RECEIVE

DENIAL OF PAYMENT WHEN THESE TWO CODES ARE BILLED TOGETHER FROM A BLUE

CROSS/BLUE SHIELD GROUP. I AM TOLD THAT THESE ARE BUNDLED.

CAN ANYONE HELP ME IN THIS AREA? THANKS

Clinic

Administrator

canelson@...

Here is what the APTA website has on this topic

HCFA DELETES CORRECT CODING INITIATIVE EDITS ON MANUAL THERAPY

In late March, APTA discovered that the Health Care Financing Administration (HCFA) would be issuing coding edits that would prohibit reimbursement for manual therapy and other therapeutic procedures provided in the same treatment session. This was part of the Correct Coding Initiative (CCI) that HCFA instituted in 1996. Specifically, the following edits would be effective, beginning April 1, 1999, meaning that if the two procedures were billed as performed in the same treatment session, reimbursement for only the " comprehensive " code would be possible, because the other code is considered a " component " of the first:

Comprehensive/Component

97110-------------97140

97112-------------97140

97113-------------97140

97116-------------97140

In a March 30, 1999, letter to HCFA and AdminaStar, APTA objected to these edits, describing them as clinically inappropriate and pointing out how they would adversely affect patient care. Moreover, these edits were implemented without providing the customary " notice and comment " opportunity. APTA requested that these edits be deleted and that providers be reimbursed retroactively for any claims denied as a result of these code pair edits. In conjunction with APTA’s correspondence, Helene Fearon, PT, APTA’s representative on the AMA Health Care Professionals Advisory Committee CPT editorial panel, contacted HCFA officials urging deletion of the edits dealing with the new manual therapy code (97140).

On April 20, 1999, APTA was notified that HCFA and AdminaStar had agreed with its recommendations. APTA received an April 14 letter from the agencies which stated: " Based on the review of your comments and issues you raise on behalf of the American Physical Therapy Association, HCFA has decided to delete " the manual therapy code pairs. HCFA indicated in the letter that:

These deletions will be reflected in the next regularly scheduled update to the CCI, Version 5.2, to be implemented July 1, 1999. The deletions will be retroactive to the effective date of the edits, which was April 1, 1999. The rs will be instructed to identify the services denied because of the application of these edits and reprocess the claims involved for proper payment. Medicare Part B providers have the option to request an appeal on these claims if they desire after the Medicare Part B rs have been notified of these deletions.

APTA members who are experiencing problems with their carriers with respect to these code edits should read the HCFA letter on our web site or contact APTA’s Fax-on-Demand to obtain a copy of the HCFA letter. It is also advisable for providers to keep track of any manual therapy denials that are based on these code edits.

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

Visit <www.PTManager.com>

TOGETHER WE CAN MAKE A DIFFERENCE !