Guest guest Posted July 10, 2006 Report Share Posted July 10, 2006 Shari, You need to append modifier -59 to 97116 since 97116 is considered a component of 97530. Documentation must support that both services were medically necessary and were done at separate and distinct times. Here is the CMS link to the CCI edits: http://www.cms.hhs.gov/NationalCorrectCodInitEd/ Rick Gawenda, PT Gawenda Seminars www.gawendaseminars.com --- caroltonrehab wrote: > Hi, We are suddenly receiving denials on billing > for gait training > 97116 on our Med B patients. > Example: on a single treatment session for 4/20 we > billed one unit > for 97110 which was paid, one unit 97116 which was > denied and one unit > 97530 which was paid. > > I've never had this happen before, can anyone help > me out with your > ideas, our billing office is also contacting her > connection for an > answer. > > > Thank You for any input, > Shari France RPT > Carolton Rehab. > 203 255-3573 ext 316 > > > > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2006 Report Share Posted July 10, 2006 Shari: Where are you located and who is your carrier/FI? This may make a difference. The denials we typically see for gait training are for patients who are not actually receiving " training " but who are ambulating for endurance. In this case, the gait would be related to endurance as a goal and thus coded as ther ex. If you have a local coverage determination, it may specify which specific CPT codes by diagnosis which would also lead to denial. So, the info re: FI/r and LCD may be helpful. >----- ------- Original Message ------- ----- > >To: PTManager >Sent: Mon, 10 Jul 2006 14:43:01 > >Hi, We are suddenly receiving denials on billing >for gait training >97116 on our Med B patients. > Example: on a single treatment session for 4/20 we >billed one unit >for 97110 which was paid, one unit 97116 which was >denied and one unit >97530 which was paid. > >I've never had this happen before, can anyone help >me out with your >ideas, our billing office is also contacting her >connection for an >answer. > > >Thank You for any input, >Shari France RPT >Carolton Rehab. >203 255-3573 ext 316 Angie , PT President/CEO Images & Associates 407 South Shore Drive Amarillo, TX 79118 Phone- Fax- Mobile- Web: www.ptconsultant.com Email: images@... Home of The Desktop Consultant: The Rehab Department's Guide to JCAHO NOTICE: This message and its attachments may contain confidential information that is intended only for the use of the ADDRESSEE(s)named above. If you are not the named addressee or if this message has been addressed to you in error, you are directed not to read, disclose, reproduce, distribute, disseminate or otherwise use this transmission. Please notify the sender immediately by e-mail and delete and destroy this message and its attachments. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2006 Report Share Posted July 10, 2006 Sounds like you are missing your -59 modifier. 97116 needs the -59 modifier when billed with 97530 Good luck, Voorhees, PT, MS Med B denials > Hi, We are suddenly receiving denials on billing for gait training > 97116 on our Med B patients. > Example: on a single treatment session for 4/20 we billed one unit > for 97110 which was paid, one unit 97116 which was denied and one unit > 97530 which was paid. > > I've never had this happen before, can anyone help me out with your > ideas, our billing office is also contacting her connection for an > answer. > > > Thank You for any input, > Shari France RPT > Carolton Rehab. > 203 255-3573 ext 316 > > > > > > > > > > Please identify yourself, your discipline and your location in all > messages to PTManager. > > Sick of working for someone else? > Tired of fighting against POPTS? > Ready to quit the corporate nonsense of large organizations? > Visit www.InHomeRehab.com. > > PTManager encourages participation in your professional association. Join > APTA, AOTA or ASHA and participate now! > > Please identify yourself, your discipline and your location in all > messages to PTManager. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2006 Report Share Posted July 10, 2006 Sounds like a 59 modifier issue. Check your CCI edits for that billing month. You can add the 59 modifier and rebill the claim and it should be paid. Yes add the 59 modifier to the 97116 code and it will be paid. Janet Becker 1505 Long Pond Drive Warrington, Pa. 18976 cell home office fax RE: Med B denials Shari: Where are you located and who is your carrier/FI? This may make a difference. The denials we typically see for gait training are for patients who are not actually receiving " training " but who are ambulating for endurance. In this case, the gait would be related to endurance as a goal and thus coded as ther ex. If you have a local coverage determination, it may specify which specific CPT codes by diagnosis which would also lead to denial. So, the info re: FI/r and LCD may be helpful. >----- ------- Original Message ------- ----- > >To: PTManager >Sent: Mon, 10 Jul 2006 14:43:01 > >Hi, We are suddenly receiving denials on billing for gait training >97116 on our Med B patients. > Example: on a single treatment session for 4/20 we billed one unit for >97110 which was paid, one unit 97116 which was denied and one unit >97530 which was paid. > >I've never had this happen before, can anyone help me out with your >ideas, our billing office is also contacting her connection for an >answer. > > >Thank You for any input, >Shari France RPT >Carolton Rehab. >203 255-3573 ext 316 Angie , PT President/CEO Images & Associates 407 South Shore Drive Amarillo, TX 79118 Phone- Fax- Mobile- Web: www.ptconsultant.com Email: images@... Home of The Desktop Consultant: The Rehab Department's Guide to JCAHO NOTICE: This message and its attachments may contain confidential information that is intended only for the use of the ADDRESSEE(s)named above. If you are not the named addressee or if this message has been addressed to you in error, you are directed not to read, disclose, reproduce, distribute, disseminate or otherwise use this transmission. Please notify the sender immediately by e-mail and delete and destroy this message and its attachments. Please identify yourself, your discipline and your location in all messages to PTManager. Sick of working for someone else? Tired of fighting against POPTS? Ready to quit the corporate nonsense of large organizations? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join APTA, AOTA or ASHA and participate now! Please identify yourself, your discipline and your location in all messages to PTManager. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2006 Report Share Posted July 11, 2006 We are also receiving the same denial for gait training with Medicare California South. We called them yesterday, and they stated that we needed to change the patient's diagnosis code, as the code we were using does not support gait training. This is very unusual, as we billed Medicare last month for the same patient, with the same diagnosis code, and they paid for the gait training. E. , DPT Bodyscape Integrative Physical Therapy Pasadena, CA From: caroltonrehab To: PTManager Date: Mon, 10 Jul 2006 14:43:01 -0000 Subject: Med B denials <!DOCTYPE HTML PUBLIC " -//W3C//DTD HTML 4.01//EN " " http://www.w3.org/TR/html4/strict.dtd " > <html> <head> </head> <!-- Network content --> <body style= " background-color: #ffffff; " > <!--~-|**|PrettyHtmlStartT|**|-~--> <div id= " ygrp-mlmsg " > <div id= " ygrp-msg " style= " width: 530px; padding: 0 20px 0 0; float:left; position:relative; z-index:1; " > <!--~-|**|PrettyHtmlEndT|**|-~--> <div id= " ygrp-text " > <p>Hi, We are suddenly receiving denials on billing for gait training <br> 97116 on our Med B patients.<br> Example: on a single treatment session for 4/20 we billed one unit <br> for 97110 which was paid, one unit 97116 which was denied and one unit <br> 97530 which was paid.<br> <br> I've never had this happen before, can anyone help me out with your <br> ideas, our billing office is also contacting her connection for an <br> answer.<br> <br> Thank You for any input,<br> Shari France RPT<br> Carolton Rehab.<br> 203 255-3573 ext 316<br> <br> </p> </div> <!--~-|**|PrettyHtmlStart|**|-~--> <span width= " 1 " style= " color: white; " /></span> <!--~-|**|PrettyHtmlEnd|**|-~--> </body> <!--~-|**|PrettyHtmlStart|**|-~--> <head> <style type= " text/css " > <!-- #ygrp-mlmsg {font-size:13px; font-family: arial,helvetica,clean,sans-serif;*font-size:small;*font:x-small;} #ygrp-mlmsg table {font-size:inherit;font:100%;} #ygrp-mlmsg select, input, textarea {font:99% arial,helvetica,clean,sans-serif;} #ygrp-mlmsg pre, code {font:115% monospace;*font-size:100%;} #ygrp-mlmsg * {line-height:1.22em;} #ygrp-text{ font-family: Georgia; } #ygrp-text p{ margin: 0 0 1em 0; } #ygrp-tpmsgs{ font-family: Arial; clear: both; } #ygrp-vitnav{ padding-top: 10px; font-family: Verdana; font-size: 77%; margin: 0; } #ygrp-vitnav a{ padding: 0 1px; } #ygrp-actbar{ clear: both; margin: 25px 0; white-space:nowrap; color: #666; text-align: right; } #ygrp-actbar .left{ float: left; white-space:nowrap; } ..bld{font-weight:bold;} #ygrp-grft{ font-family: Verdana; font-size: 77%; padding: 15px 0; } #ygrp-ft{ font-family: verdana; font-size: 77%; border-top: 1px solid #666; padding: 5px 0; } #ygrp-mlmsg #logo{ padding-bottom: 10px; } #ygrp-vital{ background-color: #e0ecee; margin-bottom: 20px; padding: 2px 0 8px 8px; } #ygrp-vital #vithd{ font-size: 77%; font-family: Verdana; font-weight: bold; color: #333; text-transform: uppercase; } #ygrp-vital ul{ padding: 0; margin: 2px 0; } #ygrp-vital ul li{ list-style-type: none; clear: both; border: 1px solid #e0ecee; } #ygrp-vital ul li .ct{ font-weight: bold; color: #ff7900; float: right; width: 2em; text-align:right; padding-right: .5em; } #ygrp-vital ul li .cat{ font-weight: bold; } #ygrp-vital a { text-decoration: none; } #ygrp-vital a:hover{ text-decoration: underline; } #ygrp-sponsor #hd{ color: #999; font-size: 77%; } #ygrp-sponsor #ov{ padding: 6px 13px; background-color: #e0ecee; margin-bottom: 20px; } #ygrp-sponsor #ov ul{ padding: 0 0 0 8px; margin: 0; } #ygrp-sponsor #ov li{ list-style-type: square; padding: 6px 0; font-size: 77%; } #ygrp-sponsor #ov li a{ text-decoration: none; font-size: 130%; } #ygrp-sponsor #nc { background-color: #eee; margin-bottom: 20px; padding: 0 8px; } #ygrp-sponsor .ad{ padding: 8px 0; } #ygrp-sponsor .ad #hd1{ font-family: Arial; font-weight: bold; color: #628c2a; font-size: 100%; line-height: 122%; } #ygrp-sponsor .ad a{ text-decoration: none; } #ygrp-sponsor .ad a:hover{ text-decoration: underline; } #ygrp-sponsor .ad p{ margin: 0; } o {font-size: 0; } ..MsoNormal { margin: 0 0 0 0; } #ygrp-text tt{ font-size: 120%; } blockquote{margin: 0 0 0 4px;} ..replbq {margin:4} --> </style> </head> <!--~-|**|PrettyHtmlEnd|**|-~--> </html><!--End group email --> <p> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 , I am assumming you submit claims to National Heritage Insurance Company. If so, they just released a LCD that went into effect on 06/12/2006. Here is the link to the policy: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=20755 & lcd_version=6 & show=all Remember, documentation must support the use of the ICD-9CM code(s) on the claim. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital --- " pilates4u@... " wrote: > > We are also receiving the same denial for gait > training with Medicare California South. We called > them yesterday, and they stated that we needed to > change the patient's diagnosis code, as the code we > were using does not support gait training. This is > very unusual, as we billed Medicare last month for > the same patient, with the same diagnosis code, and > they paid for the gait training. > > E. , DPT > Bodyscape Integrative Physical Therapy > Pasadena, CA > > > From: caroltonrehab [mailto: > caroltonrehab@...] > To: PTManager > Date: Mon, 10 Jul 2006 14:43:01 -0000 > Subject: Med B denials > > > <!DOCTYPE HTML PUBLIC " -//W3C//DTD HTML 4.01//EN " > " http://www.w3.org/TR/html4/strict.dtd " > > <html> > <head> > </head> > > <!-- Network content --> > > > <body style= " background-color: #ffffff; " > > > <!--~-|**|PrettyHtmlStartT|**|-~--> > <div id= " ygrp-mlmsg " > > <div id= " ygrp-msg " style= " width: 530px; padding: 0 > 20px 0 0; float:left; position:relative; z-index:1; > " > > <!--~-|**|PrettyHtmlEndT|**|-~--> > > <div id= " ygrp-text " > > <p>Hi, We are suddenly receiving > denials on billing for gait training <br> > 97116 on our Med B patients.<br> > Example: on a single treatment session for 4/20 we > billed one unit <br> > for 97110 which was paid, one unit 97116 which was > denied and one unit <br> > 97530 which was paid.<br> > <br> > I've never had this happen before, can anyone help > me out with your <br> > ideas, our billing office is also contacting her > connection for an <br> > answer.<br> > <br> > Thank You for any input,<br> > Shari France RPT<br> > Carolton Rehab.<br> > 203 255-3573 ext 316<br> > <br> > </p> > </div> > > <!--~-|**|PrettyHtmlStart|**|-~--> > <span width= " 1 " style= " color: white; " /></span> > <!--~-|**|PrettyHtmlEnd|**|-~--> > </body> > <!--~-|**|PrettyHtmlStart|**|-~--> > <head> > <style type= " text/css " > > <!-- > #ygrp-mlmsg {font-size:13px; font-family: > arial,helvetica,clean,sans-serif;*font-size:small;*font:x-small;} > #ygrp-mlmsg table {font-size:inherit;font:100%;} > #ygrp-mlmsg select, input, textarea {font:99% > arial,helvetica,clean,sans-serif;} > #ygrp-mlmsg pre, code {font:115% > monospace;*font-size:100%;} > #ygrp-mlmsg * {line-height:1.22em;} > #ygrp-text{ > font-family: Georgia; > } > #ygrp-text p{ > margin: 0 0 1em 0; > } > #ygrp-tpmsgs{ > font-family: Arial; > clear: both; > } > #ygrp-vitnav{ > padding-top: 10px; > font-family: Verdana; > font-size: 77%; > margin: 0; > } > #ygrp-vitnav a{ > padding: 0 1px; > } > #ygrp-actbar{ > clear: both; > margin: 25px 0; > white-space:nowrap; > color: #666; > text-align: right; > } > #ygrp-actbar .left{ > float: left; > white-space:nowrap; > } > .bld{font-weight:bold;} > #ygrp-grft{ > font-family: Verdana; > font-size: 77%; > padding: 15px 0; > } > #ygrp-ft{ > font-family: verdana; > font-size: 77%; > border-top: 1px solid #666; > padding: 5px 0; > } > #ygrp-mlmsg #logo{ > padding-bottom: 10px; > } > > #ygrp-vital{ > background-color: #e0ecee; > margin-bottom: 20px; > padding: 2px 0 8px 8px; > } > #ygrp-vital #vithd{ > font-size: 77%; > font-family: Verdana; > font-weight: bold; > color: #333; > text-transform: uppercase; > } > #ygrp-vital ul{ > padding: 0; > margin: 2px 0; > } > #ygrp-vital ul li{ > list-style-type: none; > clear: both; > border: 1px solid #e0ecee; > } > #ygrp-vital ul li .ct{ > font-weight: bold; > color: #ff7900; > float: right; > width: 2em; > text-align:right; > padding-right: .5em; > } > #ygrp-vital ul li .cat{ > font-weight: bold; > } > #ygrp-vital a { > text-decoration: none; > } > > #ygrp-vital a:hover{ > text-decoration: underline; > } > > #ygrp-sponsor #hd{ > color: #999; > font-size: 77%; > } > #ygrp-sponsor #ov{ > padding: 6px 13px; > background-color: #e0ecee; > margin-bottom: 20px; > } > #ygrp-sponsor #ov ul{ > padding: 0 0 0 8px; > margin: 0; > } > #ygrp-sponsor #ov li{ > list-style-type: square; > padding: 6px 0; > font-size: 77%; > } > #ygrp-sponsor #ov li a{ > text-decoration: none; > font-size: 130%; > } > #ygrp-sponsor #nc { > background-color: #eee; > margin-bottom: 20px; > padding: 0 8px; > } > #ygrp-sponsor .ad{ > padding: 8px 0; > } > #ygrp-sponsor .ad #hd1{ > font-family: Arial; > font-weight: bold; > color: #628c2a; > === message truncated === __________________________________________________ Quote Link to comment Share on other sites More sharing options...
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