RE: United Healthcare Denied 97530

[Guest guest]

Lori,

If it was billed along with 97140, and is a separately identifiable service,

I would bill it with a -59 modifier. Medicare CCI edits require this, and

many insurers are beginning to follow suit.

Dave

Gray PT

United Healthcare Denied 97530

Dear Group,

We have been receiving denials from United Healthcare for the CPT 97530.

This was a payable code. Does anyone have insight?

Thank you

Lori

Holistic Physical Therapy LLC

Monroe, MI

Phone:

Fax:

Email: HPTLLC@...

Looking to start and own 100% of your own Practice?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Just a brief suggestion...

Often the best way to obtain reimbursable CPT codes and modifier information is

to go directly to your local intermediary (eg. Mutual of Omaha, Trispan,

land...) and download their LCD. (Local Coverage Determination; it used to

be called LMRP.) There are other restrictions listed -- for instance 97116

cannot be reported with 97504 (orthotics). The -59 modifier here denotes a

separate anatomic site. 97530 and 97535 combinations may be the problem with

your intermediaries: (ADLs and Ther Activities in the past have often been

considered too similar to be billed as separate interventions.) Many CPT codes

are accepted only when accompanied by certain diagnoses. Or some intermediaries

do not accept certain codes at all. Intermediaries often have subtle but

definite variations in their interpretations of the Medicare edits. e.g. Some

intermediaries allow speech to bill for 97110 separately with dysphagia, others

do not accept that code for SLP and considered it bundled in the

service-based code.

OT, ST, PT will have separate LCDs that specify this information, including the

ICD-9 codes, when relevant. The -59 modifiers are uniform (as far as I have

seen), but regardless, your intermediary LCD will specify this information in a

form easy to disseminate to staff. As the SLP example indicates, referring to

your SPECIFIC intermediary for interpretation is best. Your intermediary is

often more restrictive, but MUST be the interpretation you follow for

reimbursement.

CeCe Todd, LOTR

Education & Development

Summit Health & Rehabilitation

cecetodd@...

phone

fax

bobnotrob wrote:

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Just a brief suggestion...

Often the best way to obtain reimbursable CPT codes and modifier information is

to go directly to your local intermediary (eg. Mutual of Omaha, Trispan,

land...) and download their LCD. (Local Coverage Determination; it used to

be called LMRP.) There are other restrictions listed -- for instance 97116

cannot be reported with 97504 (orthotics). The -59 modifier here denotes a

separate anatomic site. 97530 and 97535 combinations may be the problem with

your intermediaries: (ADLs and Ther Activities in the past have often been

considered too similar to be billed as separate interventions.) Many CPT codes

are accepted only when accompanied by certain diagnoses. Or some intermediaries

do not accept certain codes at all. Intermediaries often have subtle but

definite variations in their interpretations of the Medicare edits. e.g. Some

intermediaries allow speech to bill for 97110 separately with dysphagia, others

do not accept that code for SLP and considered it bundled in the

service-based code.

OT, ST, PT will have separate LCDs that specify this information, including the

ICD-9 codes, when relevant. The -59 modifiers are uniform (as far as I have

seen), but regardless, your intermediary LCD will specify this information in a

form easy to disseminate to staff. As the SLP example indicates, referring to

your SPECIFIC intermediary for interpretation is best. Your intermediary is

often more restrictive, but MUST be the interpretation you follow for

reimbursement.

CeCe Todd, LOTR

Education & Development

Summit Health & Rehabilitation

cecetodd@...

phone

fax

bobnotrob wrote:

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Hi Bob,

If you click on the 'Mutually Exclusive' link on that page that you sent a

link to, it brings you to the bottom of that page, and in the zipped excel

file for the 90000 codes, line 3006, it shows the 97140/97530 edit. I'm not

sure what the GB modifier is, but -59 means that you are identifying the

service as one that is separately identifiable. You'll want to refer to

your CPT book for more details. Hope that helps.

Dave

Re: United Healthcare Denied 97530

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Hi Bob,

If you click on the 'Mutually Exclusive' link on that page that you sent a

link to, it brings you to the bottom of that page, and in the zipped excel

file for the 90000 codes, line 3006, it shows the 97140/97530 edit. I'm not

sure what the GB modifier is, but -59 means that you are identifying the

service as one that is separately identifiable. You'll want to refer to

your CPT book for more details. Hope that helps.

Dave

Re: United Healthcare Denied 97530

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Hi Bob,

If you click on the 'Mutually Exclusive' link on that page that you sent a

link to, it brings you to the bottom of that page, and in the zipped excel

file for the 90000 codes, line 3006, it shows the 97140/97530 edit. I'm not

sure what the GB modifier is, but -59 means that you are identifying the

service as one that is separately identifiable. You'll want to refer to

your CPT book for more details. Hope that helps.

Dave

Re: United Healthcare Denied 97530

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

P.S. - 97110 and 97530 are often a problem (need modifier)...

(scroll to the 90000 series)

bobnotrob wrote:

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

P.S. - 97110 and 97530 are often a problem (need modifier)...

(scroll to the 90000 series)

bobnotrob wrote:

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

P.S. - 97110 and 97530 are often a problem (need modifier)...

(scroll to the 90000 series)

bobnotrob wrote:

I don't see a 97140/97530 exclusion in the Medicare CCI edits found here:

http://www.cms.hhs.gov/physicians/cciedits/default.asp

Where do you see it specified?

Are the -59 and the GB modifiers the same?

Thanks,

BOB

United Healthcare Denied 97530

>

> Dear Group,

>

>

> We have been receiving denials from United Healthcare for the CPT 97530.

> This was a payable code. Does anyone have insight?

>

> Thank you

> Lori

> Holistic Physical Therapy LLC

> Monroe, MI

> Phone:

> Fax:

> Email: HPTLLC@...

>

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>