While the CPT Manual may give guidelines for the use of Modifier 59, the language is rather confusing and many Physical Therapists struggle with its use. CPT code 97530 should not be reported and modifier 59 should not be used if the two procedures are performed during the same time block. For example, manual therapy might be performed for 10 minutes, followed by 15 minutes of therapeutic activities, followed by another 5 minutes of manual therapy. Alternatively, the therapy time blocks may be split. For example, one service may be performed during the initial 15 minutes of therapy and the other service performed during the second 15 minutes of therapy. Modifier 59 may be reported if the two procedures are performed in distinctly different 15 minute time blocks. ![]() >CPT Code 97140 – Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes >CPT Code 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes For therapists, Medicare uses the following example to explain the proper use of Modifier 59:Ĭolumn 1 Code / Column 2 Code - 97140/97530 Modifier 59 is used to represent a service that is separate and distinct from another service it’s paired with. When Modifier 59 is used incorrectly, it can lead to claim denial. It is also a potential red flag for the US Centers for Medicare and Medicaid Services (CMS) and commercial payers. ![]() This language can be a bit confusing, and the definition leans toward surgical procedures, however Modifier 59 does have its place in a Physical Therapy setting. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. However, when another already established modifier is appropriate, it should be used rather than modifier 59. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. Modifier 59 is used to identify procedures services that are not normally reported together, but are appropriate under the circumstances. Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Let’s look at the CPT Manual definition of Modifier 59: A modifier should never be used in order to receive a higher reimbursement or to get paid for a procedure that should be bundled with another code. Modifiers are added to CPT codes when they are required to more accurately describe a procedure performed or service rendered. Reimbursement problems can arise when the CPT code doesn’t support the ICD-10 code. Ideally, the CPT code (treatment, service, procedure) matches up logically with the ICD-10 code (the symptom, injury, etc.). Both codes are submitted to a payer for the Physical Therapist to be reimbursed. In Physical Therapists’ offices, ICD-10 codes are used in combination with CPT codes, which identify the Physical Therapy service provided during the patient’s visit. ICD-10 is now the standard of ICD coding. However, in 2015, ICD-10 (the 10th revision) was introduced, using 4 to 7 digit alphanumeric code. ICD-9 was the ninth version of the ICD coding system, connecting the health issues of patients by using 3 to 5 digit alphanumeric codes. The World Health Organization (WHO) created the ICD and still watches over it. While Physical Therapists use CPT codes to regiment the treatment of diagnoses, ICD coding is the standard international system for recording diagnoses and classifying mortality and morbidity statistics. ![]() 97110Įlectrical Stimulation, Medicare Non-Wound (Unattended)Ĭhiropractic Manipulative Treatment (CMT) Spinal, One or Two Regions ![]() Please note: CPT codes are copyrighted (1995-2019) by the American Medical Association. The Most Common Physical Therapy CPT codes: Each classifies data much like a zip code identifies a specific area and makes it easier for the Post Office to sort the mail and deliver it quickly. CPT, ICD-9 and ICD-10 are numeric representations of data that allow for more efficient data retrieval. CPT codes are used to classify medical, surgical and diagnostic services and procedures, and range from 00100 to 99499.
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